Tameside Housing Advice - Rough sleeper referral form

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Tameside Housing Advice's aim is to prevent you becoming homeless

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Street Homeless
Rough sleeper referral form

[Required fields are marked with *.]

Description of person sleeping rough

Name of person (if known):

Date of birth (if known):

Gender:

Female Male Unknown

Skin colour:

Ethnicity:

Facial Hair:

Height:

Other distinguishing features

Do they show any behavioural problems:

Do they have a history of violence or anti-social behaviour?

Do they know about this referral

Possible support needs:

Alcohol Drugs Mental Health Elderly Young Physically vulnerable

Sleeping site

Clearly describe the sleeping site (e.g. near the rear of McDonald's in Ashton)

Street name:

How long have they slept at this location:

What is the typical time they are at this location:

Further information

Is there any further information you would like to add:

Referrer name:

Agency/Organisation (if applicable):

Your email address (this is our preferred method of contact as we can update you on any outcome): *

Your IP address is: 38.107.179.227

Verification code: *
Please type the characters shown in the image for verification.
This is required to prevent spamming by automated programmes which abuse the system.

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