House to Home Referral

The ‘House to Home’ programme supports vulnerable people who have been homeless or at risk of homelessness to sustain tenancies in rental accommodation by helping them to make a house a home. This is through both practical work such as painting or light refurb or through the provision of essential household items.

Agency Details

Referral Agency

Other

A Partner Agreement must be in place with all Referral Agencies. If your organisation is not on this list, we will be in touch to discuss

Support Worker

Contact Number of support worker

Email Address of Support Worker

Client Details

Client Name

Gender

Date of Birth

Address

This refers to the address of the property where the practical work is to completed or household items delivered

Town

Postcode

Number of Adults living in the property?

Number of Children living in the property?

Other Key Information

What primary reason initiated the clients need for support

Background/Other Useful Information that will help Habitat staff assessing this form

Client risk to Habitat Staff/Volunteers (Please note that if a client does pose a risk, this would not deter them from being supported through the programme. It may mean that additional support is required)

HighMediumLow

Clients ability to engage in the programme (Where possible, clients will be encouraged to be involved in the programme. This could include assisting with the painting and practical work or selecting the essential household items)

GoodAverageLow

House to Home Support Required

Which location area is your House to Home Referral for?

Manager

Please select

Works Required

Brief outline of the works required (eg painting, number of rooms etc)

Works required risk to tenancy sustainment

HighMediumLow

Essential Household Items

Habitat Ireland can support individuals with essential household items to allow them to feel more at home. Individuals can come to one of the Habitat ReStores to select these items. The support value will be for a maximum of 5 items up to a value of £250.
Clients can buy additional items from ReStore which offer a wide range of new and used home improvement materials at 50-75% lower than retail price

Please list any essential household Items & Priority Level (High, Medium, Low)

To allow us to serve more individuals, please detail if the client has a budget or grant support to put towards the essential household items.

Thank You

Thank you for completing the House to Home Client Referral form.
We will review your requirements and will be in touch to discuss further.

Contact Information