Online Referral form

Please make sure you complete the form in full as we’d rather not have to delay the processing of your application because we’re waiting for information being resent.

Referrer Details (if applicable)

If you are completing this referral form on behalf of someone else, please make sure that you complete this section.

Applicant Details
Current Living Situation
Housing History (please list last 5 years)
Reason for Homelessness
Current Support
Support Needs
Education & Training
Ex-Offender Information
Additional information
Risk Assessment
Equal Opportunities

We aim to promote equality and inclusion to ensure fair access to the service in line with the Equalities Act 2010. These questions are used to monitor access to the service and are not used to make decisions on eligibility or allocation. We will not discriminate unlawfully and our Equality Protocol is available on request.

Authorisation

By submitting this form you agree with the following statements -

I confirm that the information contained in this document is true and includes all relevant information required to correctly assess this referral.

Referral agencies only - I confirm that I have the applicant’s authorisation to submit this application on their behalf and that the information contained in this document is true and includes all relevant information required to correctly assess this referral.

Data Consent
I understand that the information on this form which I am submitting will be processed and stored by DASH within a secure environment and will be used for the purposes of contact, risk assessment and background checks. For further details, please see our privacy policy - https://www.dashorg.co.uk/privacy-policy

If you agree with DASH processing and storing your details, please check ’YES’ below.