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Referral Form

We accept referrals from professional bodies only. These must be made through our website where there is a referral form to submit using Google Chrome. Once submitted, we will arrange to meet the young person and parent/guardian and make a decision on what service we can offer. There are waiting lists and there is a longer wait for one to one mentoring. We will do our best to include any young person on those lists as soon as we can.

Our Criteria


We are currently accepting referrals for young people who live in LU1, LU2, LU3 & LU4. This is their home address and not their school address. We are currently accepting referrals for young people aged between 8 years and 15 years (school year 10). Please do not send a referral for anyone who has not yet turned 8 years or who is 16. Please note: We focus on group mentoring with every young person for 12 months before considering one to one mentoring.

Based upon the Luton Safeguarding Children’s Board Threshold Framework, we are currently accepting referrals who sit within Level 2 and low level 3. We are not qualified to take higher than this level and so cannot provide the correct amount of care required.

For more information of our group mentoring courses click HERE

    Referred Individual

    (Note, applications can only be considered from postcodes LU1, LU2 and LU3)

    Parent, Guardian or Carer


    Referrer's Declaration

    • I have informed the parents/ carers that GHM Services are usually held in Stopsley and that transport cannot be provided.

    • I understand that GreenHouse Mentoring (GHM) will hold my information securely and use it only for the purposes of GHM work in accordance with the GHM Privacy Notice

    • I understand this information will be kept confidential, and only disclosed, without further consent, in the event that GreenHouse Mentoring is required by law to do so and that I have the right to see this information at any time.

    Preferences for Mentoring

    Tuesday-Thursday between 18:00 and 20:00Saturday between 10:00 and 13:00
    Monday-Friday daytime meetings are school-based, taking place at an education venue during open hours.
    Other meetings are non-school-based, held at the GreenHouse in Stopsley or another (non-educational) venue.

    Expected Outcomes

    Expected outcome(s) of referred individual’s involvement with GreenHouse Mentoring:

    Reasons for Referral

    Anger IssuesBehavioural IssuesBullying IssuesCommunication IssuesDemotivatedDomestic ViolenceGang AssociationLearning DifficultiesMajor/Terminal IllnessMental HealthPositive Role ModelSelf-Esteem IssuesSexual Abuse/ExploitationSocial SkillsSubstance AbuseViolenceYoung CarerYoung Parent

    Other Organisations

    Is the individual:

    Hobbies and Interests

    Are you aware of any hobbies and/or interests that it would be useful to know about during a relationship?

    Medical Conditions

    Does the referred individual have any medical conditions or issues which need to be taken into account during GreenHouse Mentoring relationships?

    Triggers and Other Information

    Is there any other information that GreenHouse should be aware of during mentoring - in particular, things that might trigger difficult or challenging behaviour? If so, please provide details below: