Homelessness - duty to refer referral form

1. Please note that this form is only to be used to refer people who are homeless or are threatened with homelessness in 56 days.
  
  If you require information or advice regarding someone that is not homeless or threatened with homelessness in 56 days, please contact housing@preston.gov.uk or call 01772 906412.
  
  This form is four pages long and could take up to 15 minutes to complete.
  
  All fields marked with * are required
2. Referrer details (to be completed by the professional)
  1. Public authority referring (e.g. prison, hospital etc.)*
  2. Role of person referring (e.g. social worker)*
  3. Name of referrer *
  4. Email address*
  5. Telephone number
  6. Name and contact details of any other person who could be contacted for further information, if not the referrer (e.g. support provider)
4. Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
  
  Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .