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REFERRAL FORM

Please note that incomplete or inappropriate referrals may be returned to the referrer.

Haven First is a registered charity, number 1064495. 
Company (limited by guarantee), number 3366848, Registered in England & Wales

Registered address 6 Ditchmore Lane, Stevenage, Hertfordshire. SG1 3LJ

Tel: 01438 354884  

Email: referrals@havenfirst.org.uk

Referral details

Referral Organisation:









Applicant information:






























Previous housing history (for last 10 years, also including periods of rough sleeping if any). Please start with most recent address:









Offending history:














To be completed by referral agency: Mini risk assessment.






PERSONAL DATA PROCESSING CONSENT FORM

The General Data Protection Regulations (GDPR) stipulate that all client data should be collected for a specific purpose, used only for that purpose and only retained if it continues to meet that purpose.

The type of personal data we will collect and process on you as a client may vary from time to time, but it will always relate to your application and further processing of your support contract.

At all times, your personal data will be treated as strictly confidential. 

The purpose of this form is for you to acknowledge and accept that Haven First holds personal data about you and to request your consent to the processing by the Charity.

Consent is not defined in the Data Protection Act. However, the European Data Protection Directive (to which the Act gives effect) defines an individual’s consent as:

 

…any freely given specific and informed indication of their wishes by which the data subject signifies their agreement to personal data relating to them being processed.

I have read and understood this Consent Form.  I understand that by signing this form, I explicitly consent to Haven First processing any sensitive personal data relating to me, including but not limited to my medical reports, details of spent and unspent criminal convictions and Equality Monitoring data.  I understand that Haven First needs to process this data as necessary for the performance of my License Agreement. 

Further, I consent to the Organisation providing my personal data to a third party where this is necessary for the processing of my housing application and further processing of my support contract.

 

Your data will not be shared with any third parties outside the EU without further consent.

 

I understand that my consent can be withdrawn or the processing of my data restricted and that I have the right to access the data the Organisation holds about me; rectify the data if inaccurate; erase the data (unless the Organisation has a lawful reason for processing or storing the data); port the data in order to share my data with another Organisation (for example the Council). Further information, including the privacy policy can be found on our website-www.havenfirst.org.uk. You can also write to the Data Protection lead at Haven First, 6 Ditchmore Lane. Stevenage, Herts, SG1 3LJ.



EQUAL OPPORTUNITIES MONITORING FORM

The information contained on this page is used for monitoring purposes only, which helps us to ensure that our equality and diversity practices, procedures and policies are being adhered to . Please be assured that it will not affect the decision about your application.


When you have completed this referral, please press the 'submit' button below - you will only need to press this once.