Professional Referral

IMPORTANT INFORMATION FOR REFERRING PROFESSIONALS

Once we receive your referral, UKeff will contact the client directly to request further documentation. This may include some or all of the following:

Proof of ID for the client, their partner, and any children in the household
A full Universal Credit statement
Proof of any other income received by the client or their partner
Bank statements for the last 3 months from all accounts held by the client, their partner, and any adults living in the household (including adult children)
A copy of the full tenancy agreement
Proof of all outgoing bills
Proof of any outstanding debts

⚠️ Please ensure your client is aware that this information will be requested. We cannot proceed with the assessment or provide support unless the required documents are supplied.

👉 If you are able to send us any of these documents with your referral, or assist your client in providing them, this will help us to process the application more quickly and efficiently.

Client Contact Details

Client Name *

First

Last

Client Address *

Address Line 1

City

State / Province / Region

Postal Code

If rough sleeper or homeless, please provide hostel details or other contact point

Client Email

Client Mobile

If available

Client date of birth *

Client gender *

Male
Female

Client's spoken language *

Please enter ALL languages your client knows (including English if applicable)

Interpreter needed for client? *

Yes
No

Number of adults in client's home (including client) *

Number of client's children (under 18) LIVING WITH client *

Select 0 if client has no children

Referrer Contact Details

Referrer Name *

First

Last

Referrer Job Title *

Agency Name and Address *

Referrer Telephone *

Office telephone number

Referrer Mobile *

Mobile number

Referrer Email *

Email

Confirm Email

Other Professional Contacts

Only if necessary (eg. GP, Social Worker, Probabtion Officer)

Client Requirements

Background for referral *

Please add the relevant information for your referral reasons(s) with as much detail of the circumstances as possible. For example: dates homelessness/abuse began, financial status etc.

Does the client have any of the following problems? *

Please select all that apply. For clothing, please see next section.

NOTICE

Please note that due to extremely limited funding, we have had to significantly tighten our eligibility criteria for the provision of carpets and other household items. Where resources are unavailable, eligible clients will continue to be added to our waiting list for future support.

How can UKeff help your client? *

How can UKeff help your client? Please add the relevant details for the client's problems you have selected above and any subsequent needs they have. For example: household items, carpets, food support, sanitary products. For clothing, please see next section.

Clothing

We do not automatically provide clothing vouchers. We often provide new or good condition clothing items.

Does your client need any clothing? *

Yes
No

Data Protection and Confidentiality *

Tick box to confirm: The information you submit will be kept in accordance with the Data Protection Act 1998. By checking this box you are confirming that the Client is aware of, and consents to, this referral and that we (UKeff) can share all information contained in this form with the Client. The Client also consents for us to contact them directly to offer support and assistance and to maintain future contact with the referrer if the need arises. UKeff is committed to equal opportunities and seeks to assist individuals from all sectors of the community. UKeff will not tolerate the less favourable treatment of anyone on the grounds of their gender, age, race, colour, nationality, ethnic or national origin, disability, marital status, sexual orientation, responsibility for dependents, trade union or political activities, religious or other beliefs, or any other reason which cannot be shown to be justified. This policy is subject to the requirements and legislative framework as outlined in the Equality Act 2010.

Updating preview…

IMPORTANT INFORMATION FOR REFERRING PROFESSIONALS

Client Contact Details

Referrer Contact Details

Client Requirements

NOTICE

Clothing

Contacts

PROJECTS

WAYS TO DONATE