Have you been accepted as requiring services the following statutory frameworks?: Care Management (Social Services) Yes: No: Don’t Know: Secondary mental health service Yes: No: Don’t Know: Probation service or Youth Offending Teams Yes: No: Don’t Know: Drug Intervention Programme (DIP) Yes: No: Don’t Know: Homeless status: Please tick one of the following applies to you: Have you declared yourself as homeless to the Local Authority? (council) Yes: No: If yes, what was the outcome? Found homeless’ by a housing authority and owed a main homelessness duty. ‘statutorily ‘statutorily homeless’ by a housing authority and not owed a main homelessness duty. Please indicate below if you have been referred by one of the following / are referring someone to us from one of the following:- Nominate by local housing authority: LA housing department (referral): Social services: Moving from another registered provider: Probation service/prison: Health service / GP: Community mental health team: Youth Offending team: Voluntary agency: Police: Self-referral / Direct application: Other: Please indicate which type of accommodation you occupied last / are occupying now:- Housing association general needs tenancy: authority general needs tenancy:
Have you been accepted as requiring services the following statutory frameworks?: Care Management (Social Services) Yes: No: Don’t Know: Secondary mental health service Yes: No: Don’t Know: Probation service or Youth Offending Teams Yes: No: Don’t Know: Drug Intervention Programme (DIP) Yes: No: Don’t Know: Homeless status: Please tick one of the following applies to you: Have you declared yourself as homeless to the Local Authority? (council) Yes: No: If yes, what was the outcome? Found ‘statutorily homeless’ by a housing authority and owed a main homelessness duty. ‘statutorily homeless’ by a housing authority and not owed a main homelessness duty. Please indicate below if you have been referred by one of the following / are referring someone to us from one of the following:- Nominate by local housing authority: LA housing department (referral): Social services: Moving from another registered provider: Probation service/prison: Health service / GP: Community mental health team: Youth Offending team: Voluntary agency: Police: Self-referral / Direct application: Other: Please indicate which type of accommodation you occupied last / are occupying now:- Housing association general needs tenancy: authority general needs tenancy:
Direct-Application-Form-Romford-14.7.15.docx