Homeless Are they in temporary accommodation? No ☐Yes ☐ Application? (if yes please give details) Has the Service Yes No User Been Offered a New Tenancy? (if yes please give address/landlord) Are they a Yes No Current Tenant & If yes: is there any Legal NOSP or NPP Action that Court Date for Possession Suspended/Adjourned Possession Threatens their Warrant for Eviction Security of Tenure? Landlord Rent Arrears (if Date Moved any) in Is the Landlord… Are they an Yes No Owner Occupier? Give Details of the Housing Support Needed to Prevent Homelessness Service User Consent I hereby give permission for information relating to me and my housing/support needs to be recorded, processed and shared by, and between, the referring agency and The Bridge, Nottingham Community Housing Association and Youth Shelter (Housing Matters Partnership) with the understanding that this will not be disclosed to third parties without prior consent (unless there is a risk of harm to myself/others or criminal activity) Print name Date
Homeless Application? (if yes please give details) Are they in temporary accommodation? ☐Yes ☐ No Has the Service User Been Offered a New Tenancy? (if yes please give address/landlord) Yes No Are they a Current Tenant & is there any Legal Action that Threatens their Security of Tenure? Yes No If yes: NOSP or NPP Court Date for Possession Suspended/Adjourned Possession Warrant for Eviction Landlord Rent Arrears (if any) Date Moved in Is the Landlord… Are they an Owner Occupier? Yes No Give Details of the Housing Support Needed to Prevent Homelessness Service User Consent I hereby give permission for information relating to me and my housing/support needs to be recorded, processed and shared by, and between, the referring agency and The Bridge, Nottingham Community Housing Association and Youth Shelter (Housing Matters Partnership) with the understanding that this will not be disclosed to third parties without prior consent (unless there is a risk of harm to myself/others or criminal activity) Print name Date
Housing%20Matters%20Homelessness%20Accommodation%20and%20Floating%20Support%20Referral%20Form%20(2).docx