Online Referral Form

All questions with an Asterix * must be completed for the online referral to be submitted.
If the service user doesn't have their own email address, please use their ''

Personal Details

Contact Details

If you do not have a permanent address, please put 'No current address' in the contact details section

Service Scheme

Additional Information 

Alternative Contact 

Referral Agency Details

Agency organisation details

Risk Assessment

Keystage Housing requests that information regarding risk is shared with us so that we can appropriately support the needs of the service user and have a greater awareness of the aspects of their life where they may need support to make changes. 

For HARRP referrals:

By submitting your application you are agreeing to the following terms:

  1. I confirm that the information provided in this application form is true to the best of my knowledge.

  2. I am happy for my details to be used for the purpose of referencing and for my chosen contacts to be contacted (including those outside the EEA), with personal information which has been provided in this form to allow them to verify the information about my earnings, dates of employment and previous tenancy term.

  3. I agree to all data I submit being stored online in compliance with Arthur Online's GDPR and Privacy policies.

If you do not agree with any of these terms, do not submit your application form.