Providing accommodation in County Durham | Report a Repair | Online Referral Form
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Online referral form

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To make a referral for accommodation within County Durham, please complete the form with as much information as possible, not forgetting your contact details. We do not have immediate emergency access but we will endeavour to process your application as quickly as possible.

DASH accommodation is for single occupancy so we are unable to guarantee accommodation to applicants with a partner. If you and your partner wish to apply, please complete separate application forms.

If you prefer to download and complete the form later before emailing or posting it to us, you can find that form here Referral form

Following receipt of your application we will contact you to make arrangements for an interview. We do not have any blanket exclusions and welcome all referrals but any offer will be made following a risk assessment. We will also let you know if we are unable to offer you suitable accommodation.

If you are referring yourself please skip the ‘Referrer name’ section.

Is the applicant:

• living in the area now or have left the area within the last 6 months and have lived there for a continuous period of 12 months before their application date or the date they left the area, or

• living outside the area now, and support or need support from someone who has lived in the area for at least 2 years, or

• in continuous full-time or part-time work (at least 2 full days a week) in the area for at least 12 months before their application date.

Only required if someone else is making the referral on behalf of the applicant.

Please make sure we can contact you to arrange an assessment.

Important: Please give details covering the last 5 years including dates moved in and out, reasons for leaving etc.
Please enter details here if 'Other' was selected from above.

Do you receive support from any of the above?
Please give further details of who supports you. Please enter 'None' if not applicable.
In which areas is support required.
Please provide details of all of these issues, including current support or medication and how these issues may affect living skills

Please give details of any education, work placements, training or voluntary work

Please provide details of any convictions. If you do not have any convictions, please enter 'None'
Please include if they have ongoing or any outstanding court appearances
Please use this space to tell us about anything which may help in this application for accommodation.
Please enter 'None' if not applicable
Please enter 'None' if not applicable
Please enter 'None' if not applicable

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.

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 -

If you agree with DASH processing and storing your details, please tick the above box and submit.
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