This form is specifically for referrals to our winter emergency accommodation for women. This accommodation is usually provided through local volunteer hosts.


If you have previously referred this client to us and their situation has changed, please email or call us with an update instead of completing this form.  


Thank you!

Please be aware that the Boaz Trust cannot accommodate people who have been convicted of offences that present a risk to themselves, others, or property - these may include sexual assault, violence, or arson. 


By completing this referral, you are confirming that your client does not have a history of any convictions that could create furthur risk if accommodated by Boaz. If you have questions about this relating to your client, please call the office on 0161 202 1056 - while we respect client confidentiality, due to the nature of the accommodation it is vital that we have this information. 


Please ensure that the client understands the Boaz Referral Privacy Notice before referring.

Please give information of any previous convictions, if applicable:
Other agency if not listed

Contact information

Referrer's name
Referrer's contact number
What type of support do you currently offer this client?
Referrer's email*
Confirm referrer's email*
Client contact number
Date of birth
Other country of origin not listed above
Main languages spoken (please separate with commas)
Level of English (0-none, 1-very little, 2-fairly good, 3-excellent)*
Mental health concerns or diagnosis?
Physical health concerns or diagnosis?
If yes, details of contact or support from social services:
Any practical and / or social concerns? (Our accommodation is in shared houses or with volunteer hosts so it is important that we have information from the referrer, including any specific vulnerabilities or risk factors, to help us identify which accommodation would be most appropriate if accommodated)
When does the client's current accommodation end? (If applicable)
Home Office number (from Application Registration Card or Home Office paperwork)

Asylum seekers (including pre-application and refused)

Does the client have a pending Section 4 or Section 95 application? (Enter a date e.g. 24/07/2015 or leave blank)
Is the client signing at an immigration reporting centre regularly e.g. Dallas Court?
Most recent refusal date (e.g. 24/07/2015 or leave blank if unknown)
Name, address and contact number of solicitor (if applicable)
Does the client have any family in the UK with leave to remain?

Refugees only

Please only complete this section if you are referring someone who has already been granted refugee status. (Please note, the following questions will not affect the offer of a space, it is for monitoring purposes only.)

Date granted refugee status (e.g. 24/07/2015)
Biometric Resident Permit Number
National Insurance Number


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