Note to referrer: If the applicant is a 16/17 year old and not a looked child this CRF must be signed off by a YSS consultant Social Worker and the Housing Development Manager before sending to a provider. Note to provider receiving this referral: This referral should not be accepted under any circumstances if approval has not been granted in the box below within the last one month. If approval has not been granted please return the referral to the originator. Approval granted Date: Reasons for approval / refusal and YSS recommendations for to access Placement Name: accommodation type i.e. supported Review Supported Lodgings, Hostel, accommodation? Date: Foyer, Shared, Female only. Please also confirm that the young person is Homeless (Southwark Judgement) and is unable to return home due to safeguarding concerns. YES NO YSS Housing Development Manager / HPS Manager Name: YES NO YSS Area Consultant Social Worker approval 1. Referrer Name of referrer Phone no Referral Organisation Email address Postal address Fax Number How long have you known the applicant? Reason for referral and supporting statement e.g. overcrowding, sleeping rough, financial difficulties, eviction, prison discharge, experiencing harassment / abuse, leaving temporary accommodation, family difficulties. Please state how soon the applicant requires accommodation: please give the reasons why the family relationship has broken down Family Relationship: and current contact with family; have extended family members been contacted; has mediation been attempted etc? Emergency Bed. Has the applicant been referred to an emergency bed? If Yes one and what is the status of the referral? I confirm that the information provided in this form is, to the best of my knowledge, full and accurate at the time of completion. Signed by referrer (please type name if Date completing on computer)
Note to referrer: If the applicant is a 16/17 year old and not a looked child this CRF must be signed off by a YSS consultant Social Worker and the Housing Development Manager before sending to a provider. Note to provider receiving this referral: This referral should not be accepted under any circumstances if approval has not been granted in the box below within the last one month. If approval has not been granted please return the referral to the originator. Name: Approval granted to access supported accommodation? Date: Reasons for approval / refusal and recommendations for accommodation type i.e. Supported Lodgings, Hostel, Foyer, Shared, Female only. Please also confirm that the young person is Homeless (Southwark Judgement) and is unable to return home due to safeguarding concerns. YSS Placement Review Date: YSS Housing Development Manager / HPS Manager YES NO Name: YSS Area Consultant Social Worker approval YES NO 1. Referrer Name of referrer Phone no Referral Organisation Email address Postal address Fax Number How long have you known the applicant? Reason for referral and supporting statement e.g. overcrowding, sleeping rough, financial difficulties, eviction, prison discharge, experiencing harassment / abuse, leaving temporary accommodation, family difficulties. Please state how soon the applicant requires accommodation: Family Relationship: please give the reasons why the family relationship has broken down and current contact with family; have extended family members been contacted; has mediation been attempted etc? Emergency Bed. Has the applicant been referred to an emergency bed? If Yes one and what is the status of the referral? I confirm that the information provided in this form is, to the best of my knowledge, full and accurate at the time of completion. Signed by referrer (please type name if completing on computer) Date
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