REFER AN EI VOLUNTEER An Early Intervention Coordinator/Deputy Coordinator must be referred by the church leader. An Early Intervention Coach must be referred by the church leader or an Early Intervention Coordinator who has known them for at least 6 months. Please provide the following details. Once complete the applicant will be emailed an online EI coach application form and the coordinator will be informed that a referral has been made. Make sure that you read and confirm the three check boxes before submission. Name of Referrer* Role of Referrer* Name of Coordinator* Email Address of Coordinator* If this coach is with a new church partner which is not on the list yet, please select .New Partner Church.*--- Select ---.New Partner ChurchAll Saints FishpondsAll Saints SidmouthAll Souls Langham PlaceAudacious ChurchAvenue Baptist Church Westcliff on SeaBedhampton ParishBeeston Free ChurchBethesda ChapelBlackpool ChurchBloxham Baptist ChurchBuckskin Evangelical ChurchBurton Family ChurchC3 CambridgeChapelfields Hub (Church Wigan)Chelsea Christian CentreChipping Campden BaptistChrist Church CliftonChrist Church LisburnChristchurch ClevedonChristians Together Bude & StrattonChurch Army ShankillChurch WiganCity Praise Centre CIOCommunity Church DealCommunity Church TadleyCornerstone Baptist Church LeedsDeeside Christian FellowshipEaston Christian Family CentreEC TransitionEI Make Believe, TrainingElim Church DewsburyEnfield MethodistEpsom Vineyard ChurchFarnham Vineyard ChurchFestival Church PrestatynFintry Parish ChurchFountain of Life ChurchFreedom Church RomseyGateway Church LeedsGlenabbey ChurchGorsley Baptist ChurchGrace Church TruroHayling Island Baptist ChurchHaywood Village ChurchHillbank Evangelical Church DundeeHilton Parish Church InvernessHoly Trinity WestcottHope Church BeaconsfieldHope Church DissHope Church HounslowHope Church OrpingtonImmanuel Church ChichesterJubilee Church CoventryKerith Community Church BracknellKings Church AmershamKings Church BeckenhamKings Church CatfordKings Church EastbourneKings Church HastingsKings Church HeathfieldKings Church KingstonKings Church LeeKings Church LewesKnighton Free ChurchLatimer Congregational Church BeverleyLiberty Church Fife (Dunfermline)Life Church WarringtonLiving StonesLooe and Morval BeneficeLoves Farm ChurchMacduff Parish ChurchMariners Chapel RowhedgeMonkstown Village InitiativeMowbray Community Church HarrogateNew Generation Church SidcupNew Life Church LetchworthNew Life Church LlanfairNew Life Church NorthamptonOaks Community Church DronfieldQueensbury Life ChurchRestore Community Church LoughtonRiverside Church Burton-on-TrentRoss-on-Wye Baptist ChurchSalvation Army WestfieldSouth Chadderton Methodist OldhamSouth Normanton Community ChurchSpa View Community ChurchSpeen Baptist ChurchSt Andrews CobhamSt Andrews CrawleySt Andrews High WycombeSt Andrews HistonSt Basils ChurchSt Donards BelfastSt James TauntonSt John's Church Stanmore (St John the Evangelist)St Johns HarborneSt Johns Methodist Church ConwySt Johns RydeSt Johns WeymouthSt Martins Church LiskeardSt Marys Bryanston Square Church LondonSt Marys CoggesSt Marys UptonSt Marys YateSt Matthews IpswichSt Matthews WorthingSt Nicholas BristolSt Nicholas Church Thames DittonSt Pauls DorkingSt Pauls EalingSt Pauls WarwickSt Pauls WorcesterSt Peters Church LoudwaterSt Peters FarnboroughSt Peters RuthinSt Peters ShipleySt Stephens West BowlingStirling Baptist ChurchTestThe Bridge Church ChepstowThe Cairn (Knowle West Baptist Church)The Community Church Wooburn GreenThe Lantern ChurchThe Vine ChurchTonbridge Methodist ChurchTrinity Community Church AccringtonUpton Vale Baptist ChurchWadsley Church, SheffieldWelshpool Baptist ChurchWest Street Christian Fellowship CreweWestwood Baptist ChurchWoodlands Central BristolWotton Baptist Church First Name of Applicant* Last Name of Applicant* Email Address of Applicant* Role of Applicant*--- Select ---CoachCo-ordinatorDeputy Co-ordinator Is this a person a member of the church that has an Early Intervention Partnership with TLG? --- Select choice ---YesNo If no, then please ensure that the referral is done by this applicant's current Church Leader. Notes I can confirm that I have talked to the applicant about this role and they are happy for me to pass on their name and email address in order to receive an application.* I can confirm that I have read the relevant Becoming a coach/coordinator documents.* Becoming a Coach Becoming a Coordinator I can confirm that I have known this person for at least 6 months and I am confident in recommending this person to be a coach and feel they meet the requirements of the role.*