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.
DATA PROTECTION ACT
The league is subject to the Data Protection Act 1984 in respect of computerized records. We will be required to disclose information held in respect of the applicant should the applicant request it unless certain limited exemptions apply.
Amongst the exemptions are:
The information contained in this form will be stored safely in accordance to Data Protection Laws. Information will be shared with staff and volunteers working and supporting the person to ensure a safe, positive and productive working relationship, in accordance with the Charity’s Data Protection Policy.
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.
What Happens Now ?
Stafford & Cannock League of Hospital Friends will contact you to acknowledge we have received the application.
We will, if needed request information from agencies working with you, we may request care plans, OAYS, probation reports and risk assessments.
If we think we are able to meet you support needs we will offer you an assessment interview.
If you are successful In your application we will place you on our waiting list for accommodation. We will then retain all information you have provided until you are housed or withdraw your application.
If your application is unsuccessful you can appeal in writing or by telephone within 28 days of us notifying you. all third party or external reported e.g care plans, risk assessments and OAYS will be destroyed if you are unsuccessful.
Stafford & Cannock League of Hospital Friends
Caxton House, Northwalls
Tel- 01785 413233