Pathfinder Referral Form

Client Data Processing Statement

(please read out in full to all Clients)

This referral form will be sent to the housing support programme that the Council has commissioned to provide this service – Depaul UK Pathfinder. A member of their staff will contact you using the information that you have provided today to conduct an assessment with you. Depaul UK will process your personal data and ask you questions about your personal circumstances so that they can:

* Assess if they can offer you support,

* Identify any risks and specific support needs that you may have, so that they can support you safely,

* Monitor trends about who is using and needing support services to plan and inform their business activities.

If you would like further information about how Depaul UK process you data please contact pathfinder.referrals@depaulcharity.org.uk or for more information about Depaul UK visit https://uk.depaulcharity.org/.

A copy of this referral form has been emailed to the above client at:

Date and Time emailed

Referral Details

Name of person making referral

Referrer contact details

Pathfinder Details

First Name

Last Name

Date of birth

National Insurance number

Nationality

Immigration status

Other Immigration Status

Ethnicity

Gender

Cisgender or Transgender

Sexual orientation [HL]

Preferred language

Preferred pronouns

Contact Details

Mobile Phone

Email

Client Contact Preference

Further information on client contact

Additional Information

ID documents

Care leaver

Pregnant

Living with Dependent children

Referral Details

Safeguarding concern

If yes please provide details (SC)

Source of referral [HL]

Referring Borough

Area

Accommodation at point of referral

Current accommodation

Other (current accommodation)

Type of tenure

Imminent risk of Homelessness at Current Accommodation

Reason for risk

Previous Support

What support can Pathfinder provide to help achieve their goals?

Any other agencies providing support

Are you aware of any risks or licence conditions that would impact on access to accommodation?

If yes please provide details (RL)

Are you aware of any reasons that would prevent a young person joining group sessions?

If yes please provide details (YPG)

Are you aware of any concerns around lone working

If yes please provide details (LW)

Referral Decision