Get Supporting Independence Service - Referral Form - Hounslow Council - Hounslow Gov

Filling out the Supporting Independence Service Referral Form is an essential step for individuals seeking support services in the London Borough of Hounslow. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively.

Follow the steps to complete the referral form successfully.

1. Press the ‘Get Form’ button to download the referral form and open it in your preferred editing tool.
2. Begin by entering your personal information in Section 1. Fill in your title, first name, surname, NI number, date of birth, home telephone number, current address, mobile number, previous five years of address history, and email address. Ensure all fields are accurately completed.
3. In Section 2, provide details about your current accommodation type. Select from the available options such as 'Private Tenancy' or 'Temporary Accommodation.' Indicate whether you are registered with a Local Authority for housing and provide any relevant LIN or reference numbers.
4. For the Income Details in Section 3, identify your economic status, whether you are employed, retired, or unable to work. Enter the weekly amounts for any benefits or income you receive, such as incapacity benefit or wages.
5. In Section 4, specify any primary vulnerabilities followed by up to three secondary vulnerabilities. Tick the appropriate boxes that apply to your situation.
6. Section 5 requires you to elaborate on the reasons for your referral. Provide as much detail as possible to explain your situation.
7. In Section 6, indicate if you have contact with any of the listed services and provide the name and contact details of the relevant professional.
8. Fill out Section 7 regarding diversity and indicate your ethnicity, sexual orientation, and whether you identify as transgender. This information helps in tailoring support to your needs.
9. In Section 8, indicate who has referred you, including the relevant agency name and your contact details. Attach any necessary documents as specified in the checklist.
10. Complete the Needs and Risk Assessment section by evaluating your needs for support across different aspects of life such as health, accommodation, and community contribution.
11. Finally, review the Declaration and Authorisation section. Ensure you understand and agree with the statements before signing the form. You may also need a professional signature if you are not signing on your own behalf.
12. Save your completed form as a PDF or another file type, and consider printing it for your records. You can also share or submit it as required.

Complete your referral form online to access the Supporting Independence Service today.