Make a Referral | The New Start Project Community CIC

1 About you

So we know who to talk to about this referral.

Your name *

Please tell us your name.

Your organisation or agency *

Please tell us where you're referring from.

Your role

Your relationship to the person

Your email *

Please give a valid email so we can reply.

Your phone *

Please give a contact number.

2 About the person you're referring

If you're referring yourself, this is about you. Share only what you're able to at this stage.

Their name *

Please give a name (first name is fine to start).

Preferred name and pronouns

Date of birth

Their contact details, if any

Where are they staying now? *

Please tell us their current situation.

Which area or council are they connected to? *

Please tell us the area.

3 Their situation and support

This helps us understand whether we're the right fit and how best to welcome them.

In a few lines, what's brought them to needing supported accommodation? *

Plain language is fine. You don't need to write a report — a short picture of where they are is enough.

Please give us a short summary.

Which of these reflect their circumstances? (tick any that apply)

Someone who has experienced homelessness Someone in recovery from addiction A survivor of domestic abuse Someone leaving prison A care leaver Someone managing their mental health Other, or would rather not put it in a box

What kind of support do you think would help them settle?

There's no fixed package — support is built around each person. This just helps us start in the right place.

4 Keeping everyone safe

So we can welcome them well and keep them, our other residents, and our team safe. A fuller risk conversation happens later — this is just what we should know now.

Are there any risks or safety needs we should be aware of?

For example: risks to themselves, risks from another person, or anything that affects where and how they're accommodated. If you're not sure, say so.

Is anyone who may pose a risk to this person aware of where they might be living?

Important where someone is leaving an abusive or unsafe situation.

5 Consent and timing

We can only hold and use someone's information with a proper basis for doing so.

Has the person agreed to this referral being made? *

Please let us know.

How urgent is this?

6 Anything else

Anything you'd like us to know that the form hasn't asked.

Additional notes

* These fields are needed so we can respond. Everything else, share what you can.

The information you provide is used only to consider and, where appropriate, progress this referral. It is held securely and is not shared with anyone outside the people directly involved in that decision, except where we are required to do so to keep someone safe or by law. For any question about how we handle information, contact us on the details below.

✓

Thank you — your referral has been received.

We'll be in touch using the contact details you gave us. If this is an emergency and someone is at immediate risk, please also call us directly on 01803 446133 so we can respond straight away.