Please note, this referral form should only be completed if you are referring yourself. By completing the form, this does not guarantee that Z2K will be able to take your case.  Please read our referral guide.
We only accept referrals for people who live in London, are below pension age, and are in receipt of, or would be eligible for, a means-tested benefit. Can you please confirm that to the best of your knowledge:

Privacy statement: please note that when you call or email us, you will be providing Z2K with some of your personal data, and we are assuming you have given us consent to hold that data. You may withdraw your consent at any time by emailing tanyasutton@z2k.org but please be aware, that if you withdraw consent, we will not be able to advise you.  View our privacy policy .