Homelessness contact form | Bath and North East Somerset Council

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Are you completing this form for yourself or on behalf of someone else, such as a friend or family member?

I am completing this form for myself

I am completing this form for a friend or family member

I work for a public authority and am referring the applicant

I work for a social housing provider

Your full name

Contact email address

Contact telephone number

What is your relationship to the person you want to talk to us about?

Which of the following best describes the public authority you work for?

Has the applicant given you permission to refer them?

Yes

Hidden tokens

Person completing form token [webform_submission:values:are_you_completing_this_form_on_behalf_of_someone_else_such_as_a]

Other person name token [webform_submission:values:your_full_name]

Other person email token [webform_submission:values:your_contact_email_address]

Other person phone token [webform_submission:values:your_contact_telephone_number]

Relationship to applicant token [webform_submission:values:what_is_your_relationship_to_the_person_named_in_this_form_]

Public authority token [webform_submission:values:which_of_the_following_best_describes_your_public_authority_]

Applicant permission token [webform_submission:values:has_the_applicant_given_you_permission_to_refer_them_]

Applicant age token [webform_submission:values:is_the_applicant_younger_than_16_years_old_]

Applicant name token [webform_submission:values:full_name]

Applicant birth date token [webform_submission:values:date_of_birth]

Applicant email token [webform_submission:values:contact_email_address]

Applicant phone token [webform_submission:values:contact_telephone_number]

Applicant other phone token [webform_submission:values:alternative_phone_number]

Contact method token [webform_submission:values:preferred_method_of_contact]

Gender token [webform_submission:values:gender]

Current situation token [webform_submission:values:which_of_the_following_best_describes_your_current_housing_situa]

Current housing token [webform_submission:values:current_housing_status]

Housing detail token [webform_submission:values:housing_status_detail]

Household type token [webform_submission:values:your_household_type]

Household pregnancy token [webform_submission:values:are_any_members_of_the_applicant_s_household_pregnant_]

Medical drug and alcohol token [webform_submission:values:medical_drug_or_alcohol_detail]

Benefits token [webform_submission:values:is_the_applicant_receiving_any_benefits_]

Benefits detail token [webform_submission:values:benefits_detail]

Local connection token [webform_submission:values:do_you_the_applicant_have_a_local_connection_to_bath_]

Previous address token [webform_submission:values:previous_address]

Risk assessment token [webform_submission:values:have_you_carried_out_a_risk_assessment_for_this_applicant_]

Risk assessment detail token [webform_submission:values:risk_assessment_detail]

Accessibility help token [webform_submission:values:accessibility_help_detail]