Stafford and Cannock League of Hospital Friends provides an Intensive Housing Management Service.
We will use the information we collect from this form only to process your application to one of our services.
We may need to request information about you from any other agencies that work with you. This will help us to fully access your application for the League’s Services.
We will ask you for your consent before we do this.
If you would like help with completing this form, please contact us at the address below and one of our staff will be glad to help you.
(E.g. doctor, social worker, probation officer, community psychiatric nurse, advocate, family, friend)
I confirm that the information I have given is correct.
I understand that if any information I haveprovided is found to be false you may withdraw any service or offer of a service, includinghousing, or if I have already moved into a League’s service you may take legal action,
This may result in you asking me to move out.
Thankyou for completing this application.
Please press the submit button to send the document to us, a copy will be emailed to you for your records.
The League will use this information solely to assess the applicants suitability to access the service. Information that you provide may be discussed with the applicant.
If any information that you provide cannot be shared or is 3rd party information, please state that this is the case on the details provided.
Please attach any supporting information.