Transitional Housing

Available rooms

Referrals

Make a referral

Referring yourself or someone else? Choose below. The form covers the applicant’s details, income, housing history, health and risk.

Start here

Who is the referral for?

I am referring myself

Go straight to your details. You do not need an agency or key worker to apply.

Refer myself

I am referring someone else

For council officers, key workers, probation, health and supported housing providers.

Refer someone else

Before you start

Have these ready

  • The applicant’s agreement to the referral
  • Their National Insurance number and date of birth
  • Photo ID to upload
  • A screenshot of their Universal Credit journal payment statement
  • An “Entitled to” benefits calculation and an income and expenditure assessment
  • Their addresses for the last five years

Applying for a specific room? Use the form on its listing under available rooms.

Referral form

Referring yourself? Use the self-referral form instead.

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Thank you for your response. ✨

Referral details

Applicant details

Universal Credit and other benefits

Are you in receipt of Universal Credit(required)
How often are you paid Universal Credit(required)

Are you in receipt of any other benefits?

Complete the rows that apply. Please note: we do not accept Pension Credit.

Household and employment

Common disability benefits are Attendance Allowance, Disability Living Allowance (DLA), Personal Independence Payment (PIP), Employment and Support Allowance (ESA), Universal Credit limited capability for work element (LCW/RA) and Statutory Sick Pay (SSP).

Other income and savings

Previous 5 year address history

Last 5 addresses.

Address 1

Address 2

Address 3

Address 4

Complete a benefits calculation at entitledto.co.uk and attach the result below.

Applicant medical background/history

Risk assessment

Violence, aggressive behaviour (verbal and/or physical)(required)
Self-harm / suicide / mental health formal diagnosis(required)
Drug/alcohol misuse(required)
Medication: non-compliance, memory issues, unintentional/intentional overdose(required)

Safeguarding concerns

Child protection issues(required)
Sexual or schedule 1 offence(required)
Criminal convictions / offences(required)
Self-neglect / neglect of others(required)
Antisocial behaviour(required)
Damage to property(required)
Neighbourhood problems(required)
Arson/firearms(required)
Rent arrears/finances(required)

Other questions/concerns

Has the tenant ever been evicted?(required)
Risk of exploitation or abuse from others(required)
Any other risks(required)
Is the applicant at risk of harm from others? Please provide details if yes.(required)
Should any precautions be taken into account when interviewing the candidate?(required)

Next of kin or significant other

Equality, diversity and inclusion

Please answer all of the below.

Does the applicant have any cultural, ethnic, religious or other specific needs?(required)
Does the applicant have any physical disability, accessibility or additional needs?(required)

Authorisation – applicant

  • I give my consent to the disclosure of this information for the purpose of finding accommodation and to the disclosure of any supplementary information attached for housing purposes, in line with GDPR regulations.
  • I give my permission for the outcome of this referral to be explained to the referral agency if required.
  • I agree to participate in coaching services which are included as part of my tenancy agreement.