DownloadsWho’s the service for?

  • Women who may have been victims of domestic abuse or at risk of domestic abuse
  • Women offenders, those at risk of offending
  • Women in need of accommodation

Advisory: We require detailed information and as a result the form is unavoidably long.

Please Note: All details submitted are held in the strictest confidence, and are only shared with any third parties in certain circumstances. See our privacy policies here.
Divider Bar - Gray (transp)

Click to Download Referral Form

Download the Word version or complete and send the secure form below:


  • Please see the guidance notes below and complete the form as best you can. This form will be sent to our support team via
  • Unfortunately we are unable to accept all referrals due to the type of accommodation and degree of floating support we are able to offer. Therefore it is necessary, to assess each applicant for suitability.

Data Protection:

  • The purpose of this form is to allow WAITS to obtain background information as necessary to start assessing those referred for accommodation or floating support for suitability.
  • If the client does not agree, the information submitted will be kept in a secure holding file until permission to proceed or otherwise has been obtained.
  • The information will be processed in accordance with the terms of the Data Protection Act 1998 and WAITS will be the controller of the data for the purposes of that Act.
  • The information will only be shared as necessary with other housing, health and social welfare agencies or bodies as may become directly involved in their support.

Referral Agency:


Client Details:

  • Other Personal Details:

  • Important: You must use one of the following 2 options


Domestic Abuse / Offending:

  • Complete this section if the client is a victim of domestic abuse and offending.
  • The Clients Tenancy

  • Points for consideration for refuge

  • If no offending history you can skip the next section!


Nature of clients offences?

  • Please describe with as much detail as possible.

Risk Profile

  • Mark all offence types for which the applicant has been convicted.
  • Summary

  • For more details on WAITS services and referrals visit this section of our website -


What will happen next?

Once the referral form and risk profile has been received we will contact you within 5 working days to discuss the referral with you and advise you if your client is eligible for our service.

If our service is not appropriate for your client we will advise on alternative services.

If our service is appropriate then we will arrange to interview the client with 5 days and we will advise you how long we anticipate before your client can access our service.

Occasionally we may have no suitable vacancies. In these circumstances, applicants will be placed on a waiting list.

Sponsored Advertisement