Menu Planning & Budgeting Skills 4 Weeks
Menu Planning & Budgeting Skills – 4 Weeks
Referral form
Before completing the form, please consider whether your client is ready to engage in the classes with the Core outcomes required on the form below and can commit to the 4 week programme (see below.)
Name:...... ……Date of Birth……………………………………
Male FemaleOther
Address:……………………………………………………………………………………………………………………
Post Code: ………………….. Phone Number (s) ………………………………………………………….
Minimum level of requirement before attending the programme
- Can your client order food in a café, restaurant or takeaway? Yes No
If yes, please give an example ------
- Can your client follow instructions to cook ready prepared foods? Yes No
If yes, please give an example ------
- Can your clientsafely use kitchen equipment & utensils? Ie safe use of knives, potato peeler, correct cooking times & temperature, turn off ovens/hobs after use? Yes No
If yes, please give an example ------
- Does your client have an understanding of basic hygiene in the kitchen?
Yes No
If yes, please give an example ------
- Can your client make basic meals for the household? Yes No
If yes, please give an example ------
- Can your client follow a recipe, written, oral, pictorial, instructions?Yes No
If yes, please give an example ------
Comments (e.g. any Special Needs, Medical, Other information?):
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………......
To which of the following ethnic groups would you describe your client as belonging?
White: Scottish
Other British
Irish
Gypsy/Traveller
Polish
Other white ethnic group
Mixed or multiple ethnic group
African/African Scottish or British
Other
Caribbean/Caribbean Scottish or British
Black/Black Scottish or British:
Other Caribbean or Black
Asian/Asian Scottish or British:Indian
Pakistani
Bangladeshi
Other Asian
Chinese/Chinese Scottish or British:
Arab/Arab Scottish or British:
Other ethnic group:
Not Known:
Referred by: ...... ………………..
Job Title: ………………......
Organisation: ...... ………………..
Address: ...... ………………..
Post Code: …………………………………………………………………………………………………………………
Telephone: …………………………………………………………………………………………………………………
Email address: …………………………………………………………………………………………………………….
Date:......
For information: The Stand – alone Menu Planning & Budgeting will run weekly for a set period of 4 weeks. The classes will take approximately 2-3 hours. One of the sessions will include microwave cooking and the 4th session will include shopping and cooking. It is important that participants will attend all the classes.A certificate and recipe book will be given to the participant at the end of the programme.
Once the form is received, we will contact you to arrange for you and your client to come in for a chat about the programme a small multiple choice questionnaire to be completed by your client and to organise a start date.
Please complete and return to: Sue O’Neill-Berest, Cookery Tutor, Cyrenians Good Food Programme, 84-86 Jane Street, Leith, Edinburgh EH6 5HG. OR email:
Please note Edinburgh City Council is funding this programme and the information on the form is required for their ECCO database.
Office use: Ack: …………..………