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SWAN Community Support Referral/Assessment 
SWAN provides a community support service to help those in need wherever possible. We will endeavour to help as much as possible within our remit and resources

Please provide as much details as possible about the requirements and we will do our best to respond to you within 5 working days. 


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Referral Type *
*External Organisation Referral - Please provide name of the organisation and the name of the person making the referral.  
* External Organisation Referral Only -  How do you know the beneficiary? 
Beneficiary Name *
First and last name
Email
Phone number *
Any other adults in household -
Please provide full names and relationship to the beneficiary.
Any children in the household -
Please provide ages. 
Address *
Borough 
(*We are unable to assist outside the boroughs listed*)
*
Immigration Status *
Support required (SWAN will help where possible or signpost to relevant service providers)  *
Required
National/Preferred Language
Any diagnosed mental health concerns
Any other relevant information. 
Recommendations/Follow Up Required *
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