Referral for housing form - Golden Lane Housing

Referral for housing
for people with a learning disability

Tailored housing
Everyone has different needs when it comes to
their home. Whether they want to live alone or
share, live in a particular location or they need
specialist adaptations, Golden Lane Housing can
help people with a learning disability to rent their
own home.
This form will enable us to gain an initial
understanding of the person’s housing need and
consider what housing options may be available.
Before completing this form
Please refer to the leaflet ‘Routes to housing and
services we provide’ in your information pack. It
may help you when completing this referral form
and also explains what else needs to be in place
before Golden Lane Housing can move forward
with this referral.
Is shared housing unsuitable
If the person you are referring needs or wishes to
live alone, please be aware that Housing Benefit
are unlikely to cover the cost of the whole rent
which will be charged by Golden Lane Housing.
This means that there is a likelihood that there
will be a rent shortfall.
A rent shortfall is when the amount of Local
Housing Allowance paid by Housing Benefit does
not cover the full cost of the rent, leaving an
amount which will need to be paid in addition to
this. The rent shortfall will need to be paid by:
• the person being referred for housing
• the support provider
• the local authority commissioning the
personal care and support package
• other (i.e. family member, someone else)
Next step
Please complete this form and send it back to Golden Lane Housing and we will be in touch shortly. In
the meantime, if you have any questions please contact our development team.
@
Golden Lane Housing, West Point, Ground Floor, 501 Chester Road,
Manchester, M16 9HU
0845 604 0046
enquiries@glh.org.uk
www.glh.org.uk
Follow us on Twitter - @GoldenLaneHouse

About the person requiring supported housing
Name
Address
Telephone number
Gender Male Female
Age
Does the person looking for No Yes
housing have a learning disability
If yes, what type of learning
disability does the person have
Does the person have any No Yes - please
physical disabilities
provide details:
These will be taken into consideration
when searching for a property
What area would they like to live
Why does the person wish to
move home
Is the person able or willing to No Yes
share a property
If no, see ‘Is shared housing
unsuitable’ Who has agreed to
pay the rent shortfall
What is the timescale for the
person to move
Does the person have paid No Yes - number of hours
support in place
agreed per week:
Cut here
Who is their support provider
or main carer
Is sleep-in support required No Yes - is this part of
their current support
package

If the person gets Disability Low Medium High
Living Allowance care component,
which level do they receive
If the person gets a Personal Standard Enhanced
Independence Payment daily
living component, which level
do they receive
What other benefits are they
receiving
What is the name of the social
worker
What is the name of the local
council
Is there any other information
that you would like Golden
Lane Housing to be aware of in
support of this referral
Key contacts details
For provision of further information
Name
Address
Telephone number
Email
Housing vacancies
We have some housing vacancies on our website that may be suitable for this person, go to
www.glh.org.uk/housing-vacancies. Have you seen any that may be of interest If so, please
quote the property reference number/s and we will refer you to the local housing officer.
Official use only
CRM enquiry ref Acknowledgment letter sent / /
Referred to Date / /
Referral ref HS call completed / /
Company Registered 3597329. Registered office address 123 Golden Lane, London, ECY1 0RT. Registered charity number 1071097 252.06/2013