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Online referral form

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To make a referral 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.

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 to the ‘Applicants name’ section.

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.
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.
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
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.
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 - https://www.dashorg.co.uk/privacy-policy

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