Client Referral Form

Please submit all relevant details below and we will aim to get back to you as soon as possible. Or if you prefer to fill in a hard copy, please download a printable form using this link and either fax or email it back to us:

Client Referral Form (PDF download)


Client Referral Form – SUBMIT DETAILS BELOW

Fields marked with an * are required

1. Referrer Details


2. Client Details

For each dependent please provide: | Name | D.O.B | Age | Gender | Relationship to you |


3. Important Contacts Information

 

If you have recently been granted refugee status and have not applied for benefits please do not tick any boxes.

Terms and Conditions

The client named in 2.1. must have given the referrer authority to submit this referral form and agrees that the referrer be advised of any outcomes should no details have been provided in 2.8.

The client must be able to provide at least 1 verifiable form of identification before any assistance with housing or reintegration support can be made.

Please note that Stride Partnership CIC will only provide support to individuals that have been recently awarded either (a) person with humanitarian protection or (b) Refugee Status with leave to remain. We do not cater to any other client groups.


Disclaimer and Declaration:

Housing history, risk assessments and additional support requirements will be assessed by us at the next stage. We may be required to share this information with external support agencies; these agencies may include, DWP, Social Services, Mental Health Services. This list is not exhaustive and we may also be required to consult with other agencies, in order to provide the client with the necessary appropriate services. The exchange of this information will be on-going to enable Stride Partnership to continue to provide the service to meet the needs of the client. At times we may also use the information for service planning, monitoring service and research.