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Emergency accommodation
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Client
Tell us about the person or people the service is for by choosing from the list below. You must make at least one choice in each section marked with a
*
. Make as many choices as you want. You can also say if you want a special service for an ethnic group.
*
= required
What describes the person, family or group?
*
Single homeless with support needs
Rough sleeper
Traveller
Homeless families with support needs
Women at risk of domestic violence
Teenage parents
Young people at risk
Young people leaving care
Offenders or people at risk of offending
Mentally disordered offenders
People with alcohol problems
People with drug problems
People with mental health problems
People with learning disabilities
People with a physical or sensory disability
People with HIV/AIDS
Refugees
Older people with support needs
Older people with mental health problems/dementia
Frail elderly
Non specialist
None of the above
Ethnic origin (choose only if you want a specialist ethnic service)
Select (if required)
Bangladeshi
Chinese
Indian
Pakistani
Black - African
Black - Caribbean
Black - any other Black background
White and Asian
White and Black African
White and Black Caribbean
White British
White Irish
White - any other White background
Any other Asian background
Any other mixed background
Age band
*
Ages 16-17
Ages 18-25
Ages 26-49
Ages 50-54
Ages 55-59
Ages 60-64
Ages 65-74
Ages 75-84
Ages 85-94
Ages 95+
or
Any age group
Type of household
*
Single men (men only service)
Single women (women only service)
Single people (mixed single men and women service)
Couples without children
Men with children
Women with children
Couples with children
All adult household
or
Any household type