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Please fill in the referral application below.

Your application can be saved securely and returned to when necessary.


How to apply
  1. Home
  2. How to apply

Step 1 of 9 - Referral Agency Details

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  • PLEASE READ CAREFULLY

    This form is for agencies and organisations referring on behalf of their client only. For self-referrals please contact sustain head office by either emailing Referrals@sustainuk.org or by calling our office on 0121 428 2221

    All sections of this form must be completed.
    Failure to do so may cause delays.
    If for any reason a section cannot be filled out, please state why.
    Blank sections will not be accepted. Additional documents can be attached and uploaded at the end of the application form.
    If for any reason you cannot fully complete this form, you can save your progress securely and resume it later. You will have 30 days to complete the form before the data is erased from our secure servers.
  • Sustain (UK) Ltd is an equal opportunities housing provider, however, we reserve the right to refuse referrals from persons with a history of arson (insurance regulations,) sex offences against children and fire arms offences.
  • Hidden
    DD slash MM slash YYYY
  • This must be accurate.
    All referrals must meet the definition of 'Vulnerable Adult' -

    "A Vulnerable Adult is someone aged 18 or over; who is, or may be, in need of community services due to age, illness or a mental or physical disability. Who is, or may be unable to take care of himself/herself, or unable to protect himself/herself against significant harm or exploitation."
Save and Continue Later
  • Please provide as much information as possible.
    If the applicant is currently living in a hospital/prison/hostel etc. Then please give that address.
    If the applicant is homeless then please type 'homeless' in the street address.
  • DD slash MM slash YYYY
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  • Previous 5 Year Address History

    Please provide as much information as you can about the previous 5 year address history.
    If there were periods where the applicant was homeless, then please write 'homeless' in the street address.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
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  • Please list all applicable details.
  • Please provide GP name and address (if applicable)
  • If appropriate this must be provided
  • Please include full details of current/previous offences. This information must be provided if applicable.
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  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please provide details of level and type of support required
  • Please specify
  • Please specify
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  • We will not accept referrals without a current risk assessment.

    Please provide information below or upload/attach a current risk assessment of your own.
    PLEASE NOTE - WE WILL NOT ACCEPT REFERRALS WITHOUT A CURRENT RISK ASSESSMENT
  • Drop files here or
    Accepted file types: pdf, doc, docx, Max. file size: 10 MB, Max. files: 5.
      Please upload relevant risk assessment in either PDF, Doc or Docx format
    • Please indicate risk level
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
    • Details - please complete in all cases
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    • Applicant Consent

    • Please click and drag to draw signature
    • Hidden
      DD slash MM slash YYYY
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    • Referral Agency Consent

    • Hidden
      DD slash MM slash YYYY
    • Please click and drag to draw signature
    Save and Continue Later
    • (This is not a necessary requirement)
      Drop files here or
      Accepted file types: pdf, doc, docx, Max. file size: 15 MB.
      • Please list information about any documents that you have attached/uploaded to this form.
      • This field is for validation purposes and should be left unchanged.
      Save and Continue Later

      WHERE TO FIND US

      2a Albert Road
      Harborne, Birmingham
      B17 0AN

      GET IN TOUCH

      info@sustainuk.org
      T: 0121 428 2221
      F: 0121 210 7799

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