Welfare support referral form

Please use this referral form to refer individuals into our Starter Pack or Acts435 services. Referrals must be made by one of our referral agencies.

You can make referrals or refer yourself to the Warm Homes Healthy People service on the WHHP referral site.

Warm Homes Healthy People is a free service which helps people who are homeless, vulnerable or poorly housed to keep ...
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Acts435 micro-grants are small crowd-funded grants of up to £120 towards household equipment, white goods, furnishings, essential furniture, court or ...
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Starter Packs are for people moving into tenancies from hostels or the streets, and contain bedding and household items. They ...
Read More

Important notes

Please note that Starter Packs and Acts435 crowd-funding are only available once to any individual, and if a referral is accepted it must be collected by the referral agency and not the person being referred.

We can only process one Acts435 referral per referrer at a time. Requests should be for a specific, costed, item (or items), up to a maximum value of £120. We do not take referrals for bonds or rent payments.

This form should be completed by an individual working at a recognised referring organisation (the "referring agent") on behalf of the intended recipient (the "applicant").

Fields marked * are required.

Referrals being made

Applicant details

Please give details of the intended recipient.

Starter pack referral

Starter Pack items requested

Please note that Starter Packs are for individuals, not families. Pack contents may vary due to availability and may include good quality donated items.

Bedding

Please tick required items and select size.


DuvetBedding setPillows


Household items

Please tick required items.

CrockeryPansCutleryCooking utensilsKettle

Acts435 referral

Referring agent

Please give your details.



Collection

Declaration

This should be completed by you as the referring agent.


Diversity monitoring

This information is optional and for monitoring purposes only. It will not be considered when assessing the referral.