Supported Accommodation Referral Form (16+)
For Local Authorities and commissioning teams to submit standard or emergency referrals for young people aged 16+. GDPR-compliant and suitable for statutory services.
SECTION A – Referrer Details
Please provide your professional details as the referring party.
Referrer full name
*
First Name
Last Name
Role / team
*
Local Authority or organisation
*
Work email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
SECTION B – Placement Request
Details about the placement required for the young person.
Is this an urgent or emergency placement?
*
Yes – emergency / same-day required
No – standard referral
Urgency timeframe
*
Please Select
Same-day
Within 48 hours
Within 7 days
Brief reason for urgency
*
Any immediate risks we should be aware of?
Type of placement required
*
Please Select
16+ supported accommodation
UASC placement
Shared accommodation
Single occupancy
Emergency / short-notice
18+ move-on support
Target move date
-
Month
-
Day
Year
Date
Will support staff be required from TIFA Life?
Yes
No
Unsure
Estimated support hours per week
Support ratio required
Please Select
None
1:1
2:1
Waking night
Other
SECTION C – Young Person Summary (Initials Only)
Please provide summary details. Do not include full names or sensitive personal data.
Young person initials
*
Age
*
Gender
Please Select
Male
Female
Non-binary
Other
Prefer not to say
Legal status
Please Select
Care leaver
UASC (Unaccompanied Asylum Seeking Child)
Homeless prevention
Looked after child
Other
Brief summary of needs and presentation
*
Known risks or safeguarding considerations
SECTION D – Additional Information
Any additional details to support your referral.
Preferred location or Local Authority area
Any specific requirements or considerations
Additional comments
Data Protection & Governance Notice
This is an initial referral only. Please provide minimal data at this stage. Full documentation will be requested following suitability review. Emergency referrals are prioritised and fast-tracked subject to suitability and safeguarding review. By submitting this form, you confirm that you have read and understood this notice.
Submit Referral
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