Unrebel Housing

Referrals

The journey starts here. Whether you are a professional seeking a place for a client or you are approaching us personally, this is where the referral process begins. Please complete the form below with as much detail as possible and we’ll begin the conversation. Please complete all relevant sections using the word ‘none’ if there is no entry.

If you are referring a client please complete the entire form. If this is a self referral please start at the Referral Recipient Information. Thank you.

Referrer Information (leave blank for a self referral)

First Name

Last Name

Organisation

Telephone

Referral Recipient Information

First Name

Last Name

Gender

Telephone

Current Housing Situation

Current Address

Offending History

Brief offending history

Support Needs

Brief support needs

Referral Source

Referral source answer

License Conditions, Probation, Electronic Monitoring

License Conditions Answer

Additional Information

Additional Information Answer

Abstinence

Is the applicant willing to abstain from the use of substances including alcohol for the duration of their tenancy?

Privacy

Tick box to confirm consent obtained from the referral recipient or given here by the recipient to share their personal information with the supported housing service and their agents.

Supported Housing in Oxford

Registered Charity 1202055

Referrals