Referral for Respite Accommodation

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This application form is to be filled out by third parties on behalf of refugees or asylum seekers based in Berkshire. The purpose of the accommodation should be for short-term respite and emergency shelter.

Section 1

Information about the third-party organisation/case worker who is referring the individual in need of accommodation.

Full Name *

Name of Organisation *

Email *

Phone number *

Preferred Method of Contact

Phone

Section 2

Basic information about the individual in need of accommodation. Leave blank any information that is unknown or not applicable.

Full Name *

Age

Gender

Female

Male

Prefer not to say

Clear selection

Nationality/Country of Origin

Language(s) spoken *

Are they capable of communicating in English *

Yes, fluently

Yes, but with some difficulty

Yes, but with great difficulty

No, an interpreter is needed

No, they have social challenges

Unsure

Other:

Are they literate in English

Yes

Unsure

Other:

Clear selection

Phone number

How would they prefer to be contacted?

WhatsApp message

Phone call

Via the contact filling this form

No preference

Clear selection

What is their current sleeping situation? *

Street sleeping

Couch surfing/staying with friends

About to be evicted from asylum accomodation

Other:

Please explain what other options are been explored to find emergency accommodation *

Use the space below to provide any details about the specific circumstances of the person in need of accommodation. For example: length of time they have spent sleeping rough, their visa status, how long they have had/been waiting for their BRP…etc. Please include any information about support you think they might benefit from, aside from accommodation, to help them transition into more stable living. Please also provide greater detail if you have any concerns for their communication skills, such as difficulties with spoken English or neurodivergent characteristics.

Section 3

Please provide detail about the ideal kind of accommodation needed.

Town or region *

Length of stay requested

Use the space below to provide any details about why you are referring the person named above. Please include any information that might highlight their vulnerability including any physical or mental challenges, the length of time they have spent without stable accommodation, and any dependents they have that need to be provided accommodation with them.

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