Warwickshire Support Service Referral Form

Welcome to P3’s support service. We can provide direct support to people in Warwickshire resolve any issues causing a risk of homelessness. We can also provide supported accommodation to people who are not currently in suitable accommodation and require a support package to help them manage a tenancy. If you would like to refer someone for support or need support yourself then please complete the online form. If you need support with your referral please call Freephone 0808 164 6220

Which service do you need?

Who are you making a referral for?

Please confirm you have the appropriate authority and consent to share the clients details with us for the purposes of providing them a support service. You must have this before you continue.

To confirm, please click the below button.

If you have previously received support from us, we can review previous records (only with your consent) to ensure we can pick-up from previous support provided.

Have youthey ever been referred to P3 or another Warwickshire Housing Related Support service before?

This helps us tailor our support offer to your circumstances and history. Ex-forces personnel may be eligible for support services and facilities specifically for individuals who have served.

Have youthey ever been a member of the forces?

Q.A) We use this information to ensure the correct provision is allocated to you and to confirm your eligibility for support.

Q.B) You must have a local connection to this area. This means you have links based on: living or working in the area, close family in the area, or other special reasons.

In which local authority area are youthey currently residing,
or looking to reside?

Do you have a local connection to this area?Does the individual have a local connection to the selected area?

Q.A) Our service is for Adults aged 25+.

Q.B) We use this information to ensure the support offer is tailored to individual needs and requirements.

Please confirm your age range.Please confirm the age range of the person you wish to refer.

Are you a Care Leaver?Is the individual a Care Leaver?

Please select all options that apply to yourtheir circumstances.

We use this information to establish how best we can help you, and to ensure you meet the eligibility requirements to receive support from our service. This information is also used to allow us to prioritise your case based on the information and circumstances you provide.

We use your name in order to address you when responding to or contacting you about your referral.

We use your relationship to the individual information to monitor the sources of our referrals and to ensure we are aware of you as a key contact for the individual being referred.

We use organisation information to monitor the sources of our referrals and to help us contact you if we need to.

We use contact information to keep you informed about your referral, and/or to contact you to clarify or discuss any information you may have provided.

We use risk information to ensure our staff are fully aware of any circumstances that may require us to take appropriate steps to ensure the safety of our employees.

Referrer Details

Risks:

 

We use your name in order to address you when discussing your referral and any future correspondence or communication in relation to your support

Our service is for Adults aged 25 or older. We use date of birth information to validate your eligibility for this service.

We use contact information to make contact about the assessment and support.

YourTheir Details

YourTheir date of birth

Please enter their in the box below

What is yourtheir best contact? Please provide one or more of the requested contact details:

We use accomodation status information to establish how best we can help you.

We use address and location information to ensure we can locate you when providing support, and to verify your residential status in Warwickshire.

YourTheir accommodation status:

YourTheir full address / current residence.

You have selected an option indicating you do not have a fixed address. Please provide a description of yourtheir location so we can make contact, or an address to which we can send correspondence.

 

We use language preference information to ensure we can locate you when providing support, and to verify your residential status in Warwickshire.

We use accessibility needs information to ensure we can adapt our service, support, and contact arrangements to fit any accessibility requirements you may have.

Preferred Language

Do theyyou have any accessibility needs?

We use this information to allow us to understand what it is you need help with, and to ensure we can correctly prioritise you if a waiting list is currently in operation.

Their CircumstancesYour circumstances

Please select any other circumstances that currently apply

We use this information to allow us to understand the reasons behind the need for support from our service.

Please briefly explain the main reason(s) you feel support is needed:

We use this information to allow us to plan future support requirements and ensure you are receiving all of the support you are entitled to based on your circumstances.

TheirYour current income support

– please select which types of income currently apply

We use next of kin information as part of our safeguarding procedures, if have concerns or in the event of an emergency we may be required to reach out to a next of kin.

We use the (optional) information about other organisations involvement to make contact with professionals with whom you are already involved with, to ensure we compliment any existing support you may be receiving and to prevent duplication or repetition.

Are there any other organisations or professionals involved in supporting the individualyou?

Colour Scheme: