Referral Criteria
To refer a person to Amazing Grace Spaces for supported accommodation, the candidate MUST meet the
following criteria:
General Criteria
1. Female only
2. Single persons only.
3. Minimum Age: 18 years old
4. Maximum Age: 50
5. Must be eligible to receive Housing Benefit.
6. Must not be using a controlled drug 1 (this includes Cannabis and legal highs).
7. No alcohol is permitted on the premises. Recovering alcoholics considered based on individual’s needs &
condition.
8. Be prepared to have random swab/urine tests if required (you need to decide
9. Must not be self-harming in an uncontrolled way.
10. Must not keep pets at the residence.

Vital Information
1. This form must have typed answers – handwritten forms will not be accepted
2. Referrals must be made by agencies on this form - self referrals are not accepted.
3. Information sharing by the referral agency is essential for a successful referral.
4. Where available the referring agency should forward any full risk-assessment and pathway plan relating to
the person being referred.
5. We must have received a FULLY completed referral form before we can interview anyone.

Add your paragraphSupport Related Criteria:
1. Must have medium support needs
2. Must have a desire to be helped towards positive change.
3. Must be willing to abide by the House Rules and License Agreement.
4. Must be comfortable with the Christian values of Amazing Grace Spaces
5. Must be willing to engage with the project and participate in meaningful activities. These would include:
volunteering, training & education, skill development, employment or other paid work etc. based on
evaluation. Target is minimum of 10 hours per week.
6. Must be willing to work with Amazing Grace Spaces weekly to meet the objectives of their Support Plan.
This will include

Please make sure you fill out this form fully with detail. This form will not be accepted if there is not adequate information. Please avoid one word answers.

This form must have typed answers – handwritten forms will not be accepted
No-one will be considered without an adequately completed referral form.
All referral forms to be emailed to: info@amazinggracespaces.org

Does the applicant have the following to present to us. Please complete all lines.

Please list last five addresses (as owner occupier or tenant)

Is the person subject to either of the following?

Please outline any convictions not considered spent under the Rehabilitation of Offenders Act

In which of the following areas is support required? If the answer is N to most of these then this is not the most appropriate accommodation

Why does the applicant want to live in this accommodation and how can it help them?
This should be in their own words.

NB: This Section MUST be completed

Please use the following definitions to answer the questions:

Does the applicant have a history/is there a risk of any of the following violent offences/incidents to others:

Is there a history or current risk of any of the following?

Please attach to the application if available

I confirm that any support by my agency will be ongoing during the applicant’s stay at the accommodation. To the best of my knowledge the information within this form is true and accurate, and I understand that if relevant information has not been disclosed, it may jeopardise the applicant remaining at the accommodation if their application is successful.

Declaration of person wanting to access Amazing Grace Spaces supported accommodation

I declare that the information I have given is true, accurate and complete, and agree that it can be passed on to Amazing Graces Spaces where necessary.

I also agree that Amazing Grace Spaces may approach other agencies or workers for further information and that relevant information can be shared with those agencies where necessary.