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S. London Office
South East Office
0800 03 08 009 Mon - Fri 09:00 - 17:00 Innovation centre Highfield drive, St Leonards, East Sussex. TN38 9UH
0208 968 0812 Mon - Fri 09:00 - 17:00 Unit 6, Pilton Estate, Pitlake, Croydon, Surrey, CR0 3RA
01273 076512 Mon - Fri 09:00 - 17:00 The Barn, 3 North Court Lewes, East Sussex. BN7 2AR
[email protected]
Call us
Call us
S. London Office
South East Office
0800 03 08 009 Mon - Fri 09:00 - 17:00 Innovation centre Highfield drive, St Leonards, East Sussex. TN38 9UH
0208 968 0812 Mon - Fri 09:00 - 17:00 Unit 6, Pilton Estate, Pitlake, Croydon, Surrey, CR0 3RA
01273 076512 Mon - Fri 09:00 - 17:00 The Barn, 3 North Court Lewes, East Sussex. BN7 2AR
[email protected]
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Make a referral for supported living

Zetetick > Make a referral for supported living
Make a referral

    Details of Referrer

    1. Please complete as much of the form as possible with as much information available. Note: * denotes mandatory responses.

    3. Applicants Details

    Click 'NEXT' to go to the next section of the referral form - Thank you for your cooperation.

    Applicants Representative

    1. Name

    3. Guest Name

      1. FlatHouseShared House
      2. FlatHouseShared House
      3. FlatHouseShared House

    Click Next to go to the next page of the referral form - Thank you for your cooperation

    Support Provider & Funding

    1. Whilst Zetetick is a Charity, ALL nominations MUST be supported under contract with the Local Authority, either direct support with Zetetick Housing or by their approved nominated Care Provider for and on behalf of Zetetick Housing.

      1. -----------

        1. YesNo

        5. Please provide a brief history on any prior tenancy arrangements and/or issues i.e. arrears, ASB, other legal actions etc

        Click Next to go to the next page of the referral form - Thank you for your cooperation

        Type of Accommodation Required

        1. This Section must be completed

          1. *
          2. *

        3. There may be issues that the applicant feels has contributed to them needing support and/or new accommodation. Please state whether they are affected by any of these areas of support need?

        4. Area of Support Need

          1. UnemploymentMental Health issuesEx-OffenderArrears/DebtSensory ImpairmentAlcoholLearning DisabilityPhysical healthImpairmentDrug UseOther vulnerability
          2. YesNo
        6. YesNo
        8. YesNo

        10. Consent for GDPR

        Thank you for completing the referral form, if you have filled all the mandatory sections, please click on submit to send the form to Zetetick housing.

        Call us free on 0800 03 08 009 and we can chat about the referral and email you out Microsoft Word based forms if you need them.

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