Welfare support referral form

Please use this referral form to refer individuals into our Starter Pack or Acts435 services.

Starter packs are for people moving into tenancies from hostels or the streets, and contain bedding and household items. Once a successful referral has been confirmed, they must be collected from The Storehouse by the referring agent (not the applicant).

Find out more about Starter Packs.

Acts435 grants are small crowd-funded grants of up to £120 towards household equipment, white goods, furnishings, debt relief order fees or other specific and urgent needs. Because they are crowd funded, they may not be fulfilled immediately or at all. Successful grants will either be made in cash to be collected from The Storehouse by the referring agent (not the applicant), or by Inn Churches purchasing the required item(s) for delivery direct to the applicant.

Find out more about Acts435 grants.

Please note that starter packs and Acts435 grants are only available once to any individual.

Warm Homes Healthy People provides help and support to keep warm and healthy in your home, from advice and energy saving devices, to bedding and food parcels. You can make referrals or refer yourself to this service on the WHHP referral site.

This form should be completed by an individual working at a recognised referring organisation (the "referring agent") on behalf of the intended recipient (the "applicant").

Fields marked * are required.

Referrals being made

Applicant details

Please give details of the intended recipient.

Starter pack referral

Starter Pack items requested

Please note that pack contents may vary due to availability and may include good quality donated items.

Bedding

Please select the required quantities.














Household items

Please tick required items.

CrockeryPansCutleryCooking utensilsKettle

Acts435 referral

Referring agent

Please give your details.



Collection

Declaration

This should be completed by you as the referring agent.


Diversity monitoring

This information is optional and for monitoring purposes only. It will not be considered when assessing the referral.



Please note: If, when you have submitted the form, you see a message saying “Sorry, there was an error. Please enable JavaScript and Cookies in your browser and try again.”, your form has submitted. Please drop us an email on ben@innchurches.co.uk so that we can track why this error is occurring.