Name: Life With Support
Address: 50

Supporting a New Start Begins Here
At Life With Support Housing Association, we make the referral process straightforward and human. Whether you’re a professional supporting someone ready for change or an individual seeking your own fresh start, we’re here to guide you every step of the way.

How to Refer

We accept referrals from:

Probation services

Social workers

Drug and alcohol teams

Recovery programmes

Housing officers

Charities

Self-referrals (with professional endorsement)

Step-by-Step Guide:

Complete our referral form (see below).

Gather supporting information: We will ask for this information once the below form has been submitted.

Risk assessment

Relevant care plans

ID or proof of benefit claim (if available)

Submit the form

We’ll review within 48 hours and get in touch to discuss next steps.

An informal assessment will be arranged (virtual or in-person) to ensure suitability and safeguard everyone involved.

If approved, we’ll agree a move-in date and provide a Welcome Pack.

Name of Refferer*

This field is mandatory

Organisation/Role/Self Referral*

This field is mandatory

E-mail*

This field is mandatory

The e-mail address is invalid

Phone Number*

This field is mandatory

Name of Service User*

This field is mandatory

Date of Birth*

This field is mandatory

National Insurance Number*

This field is mandatory

Current Address or No Fixed Abode*

This field is mandatory

Phone Number*

This field is mandatory

E-mail

The e-mail address is invalid

Do they have a support worker / keyworker?*

This field is mandatory

Current living situation Options: Prison / Rehab / Temporary accommodation / Homeless / Sofa surfing / Other (free text)*

This field is mandatory

Planned move-in date*

This field is mandatory

Is the applicant currently in recovery from substance use? Yes / No / In active use*

This field is mandatory

Primary support needs (List all that apply): Drug recovery Alcohol recovery Mental health Ex-offender Learning disability Risk of homelessness Other (Please give all information)*

This field is mandatory

Does the applicant have a keyworker or case manager? Name, service, contact info*

This field is mandatory

Any history of violence, arson, or sexual offences?*

This field is mandatory

MAPPA Level (if known)

Is the applicant subject to licence or supervision?*

This field is mandatory

Are there any known safeguarding concerns (risk to self or others)?

Registered GP name and address

Any physical health issues?

Any mental health diagnosis?

Currently on prescribed medication? If yes, please list medications

I confirm the applicant has given consent to share this information with Life With Support Housing Association for the purpose of referral and assessment.*

This field is mandatory

I confirm the information provided is accurate to the best of my knowledge.*

This field is mandatory

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

This field is mandatory

* Indicates required fields

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Thank you! We will get back to you as soon as possible.

Supporting a New Start Begins HereAt Life With Support Housing Association, we make the referral process straightforward and human. Whether you’re a professional supporting someone ready for change or an individual seeking your own fresh start, we’re here to guide you every step of the way.

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Supporting a New Start Begins Here
At Life With Support Housing Association, we make the referral process straightforward and human. Whether you’re a professional supporting someone ready for change or an individual seeking your own fresh start, we’re here to guide you every step of the way.