Organisation referral form Form guidance This form is for professionals working with people who are homeless or facing homelessness to refer their clients to us. If you are seeking support for yourself, please use this form. You should use this form if your client is Based in south Buckinghamshire (Wycombe, Chiltern and South Bucks areas) and They are already homeless or you believe the problem they are facing is likely to lead to homelessness Please ensure you have the person’s consent to share their details and make the referral to us. Next steps We will contact you within two working days to let you know whether we will accept the referral or not and what the next steps may be. Details of referrer Name Job title Organisation Phone number Email address Client details First name Last name Other names used by client Address line 1 Address line 2 Postcode Email Phone Date of birth Current housing status Housed - prevention supportHoused - ongoing tenancy supportHomeless Recourse to public funds YesNoUnknown Purpose of referral Outline reasons for the referral and the support you would like Wycombe Homeless Connection to offer Give us any information we will need to assist the client effectively and safely By clicking the “submit referral form” button below, you confirm that the data in the form has been lawfully obtained and that the client has given consent for you to make this referral to us. Our client data privacy notice is here. Our referring professional’s data privacy notice is here.