Inspire2Thrive Telford Referral Form

 
?
Enter full name of applicant
?
Enter full name of second applicant if required
?
Enter Date of Birth (DD-MM-YYYY) of first applicant
?
Enter Date of Birth (DD-MM-YYYY) of second applicant
?
Enter full name of referrer

Is there a CAF/TAC or Child Protection Plan in place?

Current housing status (please tick):

Current Financial Status

Support

Needs Assessment - What outcomes would the client like to achieve (Please tick all that apply)

Risk Indicators

This information is required to allow support workers to prepare for the assessment fully. Please give as much detail as you are aware of especially where there may be concerns for lone working.

Please note lack of information may result in a delay of the referral being processed.

*If you are making this referral for an individual that is not known to you and/or you do not consider it appropriate to complete this section, please tick the box below. (Please ensure the ‘Network of Support/other agencies involved’ details are completed in full as this will allow us to make the necessary enquiries regarding risk

Monitoring Our Services

We are committed to providing a service, which is fair and available to everyone. To help us monitor this, please answer the following questions. Your response will be kept confidential, however from time to time we will contact a sample of responses who have not taken up for the service to ensure that there is fair access to the service.

Confidentiality - Data Protection

Confidentiality – General Data Protection Regulation (GDPR)

We deal with personal and sensitive information in line with the General Data Protection Regulation (GDPR). Personal and sensitive information is what you have told us about yourself, or what other organisations have told us about you, or may tell us in the future.

We will always hold and use information in accordance with the law. This may include using it for statistical or research purposes, and to update our records. We may need to share some details about you with other organisations that have the right to see them, such as the police or social services. We will never give details to companies outside of the Thrive Partnership unless you have given consent.


Access to Information

As per the General Data Protection Regulation you have the right to access any information that we hold about you and this is called a Subject Access Request. You can find out how to submit a request by calling the Thrive Office.


Your rights under the General Data Protection Regulation

Under the General Data Protection Regulation you have the following rights in regards to your personal data:


·         The right to be informed

·         The right of access

·         The right to rectification

·         The right to erasure

·         The right to restrict processing

·         The right to data portability

·         The right to object

·         Rights in relation to automated decision making and profiling


If you have any queries in relation to your rights please contact the Thrive office in the first instance.

By signing this referral form you agree to us making necessary checks in order to assess your suitability for accommodation. These checks may include requesting references from previous landlords and external services who offered a service to you or from those who had been previously offered a service to you.  

Applicant Confirmation

 
Once you are happy that you have added all of the required information, please click the submit button below