Tenant Referral Form

This form is designed to collect the information that EHSL requires to understand the housing needs of the person being referred for supported housing, in order that EHSL can determine whether it is able to offer accommodation to the person whom an application has ever been made. Please ensure that every question is answered and that where supporting documentation is requested, that it is provided or made available. EHSL will be unable to offer accommodation or complete an application without the information required being provided.

Personal Details

Housing Requirements 

Are the following features required in the accommodation?

Please note: the greater number of essential requirements means the more time you may have to wait for accommodation to be sourced or become available

Support requirements 

Please provide contact details for the applicants social worker

Does the applicant need help with any of the following?

Note: Schedule 2 Part II of the Housing Act 1988 reads: 'Grounds on which Court may Order Prossession........ 17. The tenant is the person or one of the persons to whom the tenancy was granted and the landlord was induced to grant the tenancy by a false statement made knowingly or recklessness by ---(a) the tenant or (b) a person acting on the tenants instigation.

Mental Capacity 

Note: if a tenant lacks capacity into the agreement it can otherwise be signed by a power of attorney or deputy appointed by the Court of Protection. To comply with the Mental Capacity Act 2006 and the guildlines issue by the Court of Protection you will need to provide proof of the deputyship order issued by the Court of Protection. If an order cant be provided or the tenant has been assessed as lacking capacity to sign the agreement but a deputy hasn't been appointed a license may be prior to the order being received.

Note: For Council Tax purposes it is considered as being severely mentally impaired if he or she has a severe impairment of intelligence and social functioning however causes which appears to be permanent

Income and Benefits 

Is the applicant in receipt of the following welfare benefits(where applicable, Please fill in amount per week and date awarded in the text box below)

Note: if you hold more than £16 000 saved you will not be eligible to claim Housing Benefit

Consent to discuss application and share information 

Are you happy to share the following information/documents with us, or authorise the relevant bodies to do so?

Note: This will assist EHSL to ensure the tenant is claiming the correct benefits exemptions and rate of Housing Benefit. If you grant consent to share this information but cannot provide it we will speak to the holders of this information (such as DWP Social Services Housing Benefit etc.) to obtain a copy

Other Information 

Signatures and Declaration 

I declare that the information that I have provided is correct and complete 

I understand and agree with the following:
- EHSL will use this information to determine whether it can offer supported housing to the person being referred.
- EHSL may use any information provided on this form in connection with this.
- EHSL and the nominated care provider will share information relating to any tenancy issued, including the rent amount and any matters that may constitute a breach of tenancy.
if inaccurate or incomplete information is provided and a tenancy is issued, any housing benefit award may be restricted below the level of the rent and the tenant will be required to contribute to the rent from their other income or savings.