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Housing Support Referral

1Your Details 2Enquiry Details

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    Your Details


    Enquiry Details

    Client Information

    Household - Please give details of any adults who live with you

    Current and Historical Services

    Never had independent accommodation Supported accommodation History of abandoning tenancies History of sleeping rough History of rent arrears Prison

    Accommodation Needs

    Debt Overcrowding Relationship breakdown Fleeing domestic abuse Neighbour dispute Abandonment Offending Current rent arrears Difficulty managing rent Landlord dispute Landlord issued notice Unable to cope Eviction

    Support needs

    Preventing homelessness Budgeting skills Managing accommodation Feeling safe Safety of others Community involvement Managing relationships Setting up and managing first tenancy Leading a healthy and active lifestyle Education/employment/volunteering Other (please detail)

    Domestic abuse Alcohol use Substance use Offending history Vulnerable to exploitation Vulnerable to abuse Learning difficulty Difficulty reading/writing Development disorder (e.g. Autism) Physical/sensory disability Learning disability Care leaver Refugee status Mental health Other (please detail)

    Floating support Self-contained supported housing Shared supported housing Supported lodgings (Age 16-21) Short term hotel Other (please detail)

    Risk Assessment

    Please note, this referral will not be accepted if this section is not completed

    Equality and Diversity Monitoring