Referral Form

  • Referral Form

  • Referrer Details

  • Is this referral from a Council/Local Authority, or Statutory Service?*
  • Does the individual have an accepted duty to be housed?*
  • Will the duty be retained if the individual is accepted by Safe Haven Sussex?*
  • Does the individual have a local connection? (Been in Brighton for the last 6 months or for 3 years in the last 5 years)*

  • Client Information

  • Date of Birth*
     - -
  • Preferred Method of Communication
  • Do you have any accessibility requirements with regards to communication?
  • Is English your first language?*
  • Are you a British Citizen?*
  • Which of the following apply to you?*

  • Address History

    We require 3 years address history with details of why you left the accommodation
  • Date you moved into your most recent accommodation*
     - -
  • Date you moved into your previous accommodation
     - -
  • Date you moved into this accommodation
     - -
  • Do you have a bank account?*
  • Income Currently Being Received*

  • Support Requirements

  • Rows

  • Safe Haven Sussex CIC provides Intensive Housing Management and Support to all our residents. If you do not require support to manage your accommodation or have any other personal support needs, then this service may not be suitable for you. 

  • Please provide details of your Support Needs

  • Daily Living Skills*
  • Self-Care*
  • Budgeting*
  • Literacy and Numeracy*
  • Using Computers/IT literacy*
  • Social Support*
  • Seeking education, employment or training*

  • Physical Health

  • Do you have any physical health conditions?*
  • Do you have any physical health conditions?*

  • Mental Health

  • Do you have or have you ever experienced any mental health conditions?*

  • Drugs/Alcohol Use

  • Do you understand that this is a "dry" service?*
  • Do you currently, or have you ever had any episodes of problematic use of drugs or alcohol?*
  • Have you had any episodes of drug or alcohol use in the last 12 weeks??*
  • Are you engaging in support for drug or alcohol use?*

  • You have not listed any Support Needs. Please review your choices.

    Safe Haven Sussex CIC provides Intensive Housing Management and Support to all our residents. If you do not require support to manage your accommodation or have any other personal support needs, then this service may not be suitable for you and you will not be able to continue with the referral 

  • Safety and Risk Management

    Please give details of any known risks to self or others, and behaviours that may be challenging to staff or clients.
  • Any Known Risks to Self*
  • Any Known Risks to Others*
  • Any Known Risks from Others*

  • Criminal Offences

  • Have you ever been convicted of a criminal offence, or are you currently awaiting an outcome of a charge?*
  • Rows

  • Most recent offence:

  • Was this a Custodial Sentence?*
  • Date*
     - -
  • How many further offences if any*

  • Previous offence 1:

  • Was this a Custodial Sentence?*
  • Date*
     - -

  • Previous offence 2:

  • Was this a Custodial Sentence?*
  • Date*
     - -

  • Previous offence 3:

  • Was this a Custodial Sentence?*
  • Date*
     - -
  • Are you on Probation Order or License*

  • Declaration

  • Right to Rent

  • As an accommodation provider, Safe Haven Sussex has a duty to ensure prospective residents have the right to rent in the UK. One of the relevent documents will be required before the referral can be processed. 

    • a passport
    • a travel document issued by the Home Office
    • an immigration status document sent to you when you were given permission to stay in the UK

    Your passport, travel document or immigration status document needs to have a Home Office endorsement in it - for example, a stamp or a vignette (a sticker).

    This must say that you have one of the following:

    • indefinite leave to enter or indefinite leave to remain in the UK
    • no time limit to your stay in the UK
    • a certificate of entitlement to the right of abode
    • exemption from immigration control
    • limited leave to enter or limited leave to remain in the UK, or permission to stay for a time limited period - this must cover the time you’ll be renting
    • a certificate of entitlement to readmission to the UK

    You can no longer use a physical biometric residence permit or card to prove your right to rent - you’ll need to get a share code instead.

    If you cannot provide one of the above documents please contact the referrals officer who will be able to provide you with further instructions:  Referrals@safehavensussex.org.uk 

  • Do you require a Right to Rent Code?*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: