Make a referral

Who is making this referral?

Choose the option that best describes you.

I am making this referral as a… (required)

ProfessionalFor example a GP, social worker, council or housing officer, probation, or a Home Office accommodation provider Voluntary or community organisationFor example a charity, community group, faith group or refugee support organisation Self-referralI am referring myself On behalf of someoneA family member or friend

Your details

So we can get back to you about this referral.

Your full name (required)

Organisation or agency

Role or job title

Email address (required)

Phone number

Your relationship to the person being referred

For example: their social worker, support worker, sister, friend.

Details of the person being referredAbout you

Tell us as much as you know. Only the name and date of birth are required.Tell us as much as you are comfortable sharing. We need your name, date of birth and a way to contact you.

Full name (required)

Date of birth (required)

Gender

Contact number

Email address

Please give a phone number or an email address (or both) so we can contact you.

Where are theyare you staying at the moment?

Include a town or postcode if you can.

National Insurance number (if known)

Leave blank if they doyou do not have one.

Preferred language

Is an interpreter needed?

Yes No Not sure

Immigration status (if relevant and known)

Best way and time to contact themyou

For example: text first, weekday afternoons.

Is it safe to leave a message?

Yes No Not sure

Service required

Tick everything that might help. If you are not sure, that's fine.

Which services are theyare you interested in?

Supported accommodation (adults) Young person accommodation Alcohol & substance use recovery Independent living skills support Not sure, please advise

Current circumstances

This helps us understand how urgent the situation is.

What is the current accommodation status? (required)

Rough sleeping Sofa surfing Temporary or emergency accommodation At risk of homelessness In supported housing Moving out of foster care / leaving care Leaving asylum accommodationFor example after a Home Office decision Other

Describe the situation

Local connection or preferred area

For example: family in Portsmouth, works in Southsea, needs to stay near a college.

Support needs

Tick any that apply. This helps us plan the right support.

Alcohol misuse Drug misuse Mental health Offending history / on probation Domestic abuse Young person housing Physical health or disability Other

Give details

Services they areyou are currently working with

For example: GP, recovery service, probation, social worker, refugee charity.

What do theydo you hope to achieve?

Risk & safety

These questions are optional, but honest answers help us keep everyone safe and offer the right support. Write "none known" if that applies.

Any risk to themselvesyourself, and any past harm

Any risk to others, and any past harm

Any safeguarding concerns

Any history of abuse, harm or incidents related to a previous placement

Health & medication

Only share what is relevant to finding the right accommodation and support.

Relevant physical or mental health information and history

Current medication

Ongoing medical or mental health treatment or therapy

Accessibility needs or reasonable adjustments

Supporting documents

Please email any assessments, risk documents or care plans to admin@olukazzy-enterprise.org.uk with the person's name in the subject line.

Email documents

Consent & declaration

Please read and tick each statement.

I consent to making this referral. (required)

I consent to Olukazzy Enterprise sharing and processing this information to assess suitability for support, in line with our services and policies. (required)

I understand that information may be shared appropriately with relevant partners and agencies to coordinate effective support. (required)

The person being referred knows about this referral and has agreed to it, or I have explained below why they could not be asked. (required)

If the person could not be asked, please explain why

Information is sent securely to our referrals inbox, seen only by the Olukazzy team, and used only to assess and arrange support. Read our privacy notice.

Review & submit

Check your answers. Use "Change" to edit a section, then send the referral.

There is a problem

Who is making this referral?

Your details

Details of the person being referredAbout you

Service required

Current circumstances

Support needs

Risk & safety

Health & medication

Consent & declaration

Review & submit