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Refer Someone for Support

Please complete this form to refer an individual or family to Beyond Shelter UK. All information is treated confidentially.

1. Referrer Details

Full Name *

Job Title (if applicable)

Organisation

Email Address *

Phone Number *

Are you the service user?

2. Service User Information

Full Name *

Date of Birth *

Phone Number

Email Address

Current Address

Immigration Status

Preferred Language

3. Child's Details

Child's Name

Date of Birth

Gender

Status

4. Accommodation Needs

Currently in hotel / B&B?

Unsuitable housing concerns

Accessibility needs

5. Safeguarding and Risk Factors

Known safeguarding concerns (tick all that apply):

Domestic abuseMental healthSubstance misuseRisk of family breakdownOther

Allocated social worker?

Social worker's contact details

6. Support Needs

Parenting supportHousing advocacyBudgeting / BenefitsEducation / TrainingEmotional wellbeingSignposting

7. Consent

I confirm the service user has consented to this referral.I have explained how their information will be used and stored.

8. Upload Documents

9. Declaration

Referrer's Name *

Date *

Beyond Shelter UK

Beyond Shelter UK supports homeless individuals, abuse survivors, migrants, and people in crisis across the United Kingdom by providing shelter, safety, emotional support, and pathways to recovery.

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