Rotherham Referral

Applicant Details

Referring Agency Details

The referral process may be delayed if risk information is not completed

Indicate any risk issues that are relevant

Dependency Record

Criminal Record (please not this information must be filled in)


Physical Health

Mental Health/Learning Disabilities

Financial Details

Previous Accommodation


You do not have to tell us anything you do not want, however, the more information that you can give to us, the more opportunity there is to get our decision right, both for you and for our scheme. Telling us about drug or alcohol use, of any kind, will not stop you from accessing our services and Target can offer you support regarding these.

Target has a duty to inform Statutory Services of any known illegal activity, or child protection concerns.

The information you give us will be shared within the team at Target. We will also share information at our discretion, with named organisations involved in your life. These professionals must be names in the referral we received on your behalf, or agrees with you in your support package (a document produced with you once you are in our scheme). We will not pass on private information with any other party, even your family members, without your written permission.