The purpose of this form is to make an application for:
- Supported Accommodation: accommodation for those who are homeless and have housing related support needs, or support needs which affect a person living independently
- Floating Support: support provided in a customer’s home or at a drop in session in a community setting. Support is offered for customers with housing related needs; who are at risk of homelessness and require homelessness prevention support. Applicants must have a tenancy or own a home in order to be eligible for this support
The referrer must complete this form with the full knowledge and assistance of the applicant.
If this is a referral for mental health support this form must be completed by the lead professional who is supporting the applicant.
Please note that any referral made will have to meet the criteria of the service provider, a referral to a service does not equate to automatic acceptance. To ensure the referral is assessed to the right service provider you must supply as much detailed information as possible relevant to the application.
Completing this form
Please be aware that our system will 'time out' after 10 minutes.
As part of your application you’ll need to upload scanned copies of supporting documents. Please note that this form will only accept uploaded documents in either .pdf or .jpg formats.
We strongly suggest that you prepare such documents before starting this form so that you can locate them easily, and within the time limit. It is not possible to save partially completed forms, nor to retrieve information if the time out period is reached.
Supporting documents may include:
- Safety Management Plan (SAMP)
- Care Plan (CPA)
- Offender Assessment System (OASYS)
- Safety Plan
- Management Plan
Referrals received without the required additional documents will not be processed.
Your privacy and security
Please do not use this form to send anything of a confidential nature, for example, your credit card or bank details.
We do not rent, sell or trade your personal information; please see our privacy statement.
Any personal information you provide will be kept in accordance with the Data Protection Act 1998. If we receive an enquiry under the Freedom of Information Act, we will only disclose information we have been provided with in accordance with the relevant legislation.