Accommodation + Training & Social Enterprise

REFERRAL ELIGIBILTY CRITERIA		Accommodation	Training and Social Enterprise
Offending Background	Hold a conviction or have a history of offending behaviour.	☑	☑
Age	Be aged 18 years or older.	☑	☑
Homeless/Risk of Homelessness	Referrals to the PACE accommodation service are restricted to men who are homeless or at risk of homelessness.	☑	N/A
Probation Referral Only	PACE accommodation service is restricted to probation officer referrals only.	☑	N/A
Open to Referral Agents & Self-Referral	T&SE is open to probation, community support services, and self-referrals.	❌	☑
Harmful Sexual Conviction	For applications with convictions for harmful sexual behaviour, please refer to the PACE Prevention Services referral form.	⚠️	⚠️
Arson	For applicants that hold a conviction for arson, contact PACE for a specific risk assessment prior to completing the referral.	🔥	🔥

Please tick which service(s) you are making the referral to:*

Accommodation 1Training & Social Enterprise 2
All parts of this form must be completed for probation referral. For non-probation referrals, please skip section 2.
1. PERSONAL DETAILS
Name:*

First NameLast Name
DOB:

MonthDayYear
Age:
Nationality:
Contact No:
Please enter a valid phone number.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If in custody state which Prison:
Earliest Date of Release:
1: PACE Accommodation Service provides supported transitional accommodation for men leaving prison on a pre and post release basis and also to men in the community under probation supervision that are homeless and in need of support.

2: PACE Training & Social Enterprise project provides a training, education and work experience for adults with criminal convictions or an offending background.

2. Probation Officer to complete ONLY

LEGAL STATUS (e.g. TR, Full Release, PRSO, PSSSO etc)
Current offence(s):
RemandSentenced
Date of next Court hearing:
Purpose of next court hearing:
Prison Probation Officer (if applicable):
Phone:
Please enter a valid phone number.
Community Probation Officer (if applicable):
Phone:
Please enter a valid phone number.
Sentence
Date of sentencing:
Estimated date of release:
Earliest date for TR:
Conditions of release/length of supervision order:
Applicants serving life sentence:
Parole Board current recommendations:
Details of any previous Parole decisions and instances of returns:
Details Has the applicant any outstanding offences, orders, compensation or fines?

YesNoDon’t know
Details:
If applicant is being referred from a prison setting, what is their Incentivise Prison Regime level,

Basicstandardenhancedstandard & on waiting list or have restricted access to structured programmes
Details:

3. OFFENDING HISTORY

Please provide details of the applicant’s offence history
Current/most recent offence (incl. date of conviction; sentencing outcome)
1. How many times has the applicant been in prison (including this time)?
2. Has the applicant ever been convicted of any of the following offences

ArsonHarmful sexual offenceDrug DealingDrug TraffickingViolenceOrganised crime offenceHate crimesManslaughterMurder
Violence used/intended/threatened/planned (e.g., weapon, excessive physical force, false imprisonment) Detail:
Previous Offence History*

4. RISK ASSESSMENT
ASSESSMENT*
Is the applicant a risk to themselves or do they have a history of self-harm, suicidal ideation or attempted suicide?

YesNo
If yes, please give details:
Is the applicant at risk of violence from others? (incl. if under protected segregated in prison; drug debt intimidation etc)

YesNo
If yes, please give details:
Is the applicant likely to pose a community safety concern in PACE services (e.g. victim impact issues in the D17 or D9 areas)?

YesNo
If yes, please give details:

9. SUPPORT INFORMATION
Please provide a synopsis of relevant aspects from any psychological report; Parole Board report and any evaluations, assessments, carried out whilst in Prison, to direct PACE’s support & advocacy for the applicant if accepted to PACE.

10. DECLARATION

By submitting this form, you are confirming that you have fulfilled the obligations placed on the collection and processing of personal and special category personal data as outlined by GDPR and that the data submitted to PACE in this form has been collected and processed in compliance with GDPR.
Declaration

I have completed the referral form and attached appropriate supporting information and/or reports and obtained my clients consent to submit the details included on this completed form and supporting documents.

Referral Agent:
Signed:

Clear
Date:

MonthDayYear
Referring Probation Officer
Prison or community based in
Support service referralSelf-ReferralOther
Email:
example@example.com
Contact telephone number:
Please enter a valid phone number.
Should be Empty:

PACE Referral Form