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Referral forms
Referrer Information
Full Name
Organization/Agency
Job Title
Email Address
Phone Number
Relationship to Applicant
Case Manager
Family Member
Self-Referral
Other
Applicant Details (The Person Being Referred)
Nextsmartstep supports adults aged 18 and over.
Applicant Name
Date of Birth (Must be 18+)
Current Housing Status
Homeless
In Custody
Supported Housing
Temporary Accommodation
Other
Gender
Male
Female
Non-binary
Prefer not to say
Contact Number
Support Needs & Eligibility
Primary Support Area
Homelessness Support
Ex-Offender Reintegration
Substance Misuse Recovery
Mental Health / Wellbeing
Required Services
Behaviour Support
Tenancy Support (Life Skills, Financial Inclusion)
Resettlement Support
Brief Background / Reason for Referral
Risk & Safety
Since the site mentions “Risk Assessments” and “Safe Environments.”
Are there any known risks to self or others?
Yes
No
If yes, please provide brief details
Consent & Submission
Consent
“I confirm that the applicant has given their consent for this referral and for their data to be shared with Nextsmartstep.”
Privacy Policy
“I have read and agree to the Privacy Policy.”
Submit Referral
Referrer Information
Full Name
Organization/Agency
Job Title
Email Address
Phone Number
Relationship to Applicant
Case Manager
Family Member
Self-Referral
Other
Applicant Details (The Person Being Referred)
Nextsmartstep supports adults aged 18 and over.
Applicant Name
Date of Birth (Must be 18+)
Current Housing Status
Homeless
In Custody
Supported Housing
Temporary Accommodation
Other
Gender
Male
Female
Non-binary
Prefer not to say
Contact Number
Support Needs & Eligibility
Primary Support Area
Homelessness Support
Ex-Offender Reintegration
Substance Misuse Recovery
Mental Health / Wellbeing
Required Services
Behaviour Support
Tenancy Support (Life Skills, Financial Inclusion)
Resettlement Support
Brief Background / Reason for Referral
Risk & Safety
Since the site mentions “Risk Assessments” and “Safe Environments.”
Are there any known risks to self or others?
Yes
No
If yes, please provide brief details
Consent & Submission
Consent
“I confirm that the applicant has given their consent for this referral and for their data to be shared with Nextsmartstep.”
Privacy Policy
“I have read and agree to the Privacy Policy.”
Submit Referral