Support Referral Form

    You should complete this form with details of any household member or family that you consider to be vulnerable.
    Details of vulnerable resident


    Phone number

    Date of Birth

    Referral information
    Please state which of the following categories the resident you are referring meets. Please note: any referrals pertaining to domestic abuse/harassment should first be referred to

    Please use the space below to give as much information as possible for referring this resident for support:

    Household information
    Please list the name, dates of birth and relationship to tenant of all other household members:

    Your name

    Relationship to the person being referred


    The information you provide on this form will be used by Eastlight to process your data as part of the Housing Related Support referral service and to decide the level of support we or our selected social welfare partners will provide to you or the person you have referred. Eastlight has a legitimate interest in ensuring that our tenants are adequately supported throughout their tenancy with their housing related needs and welfare provisions.

    For further information regarding how we may use, store, process and share your personal information please visit our website to view Our Privacy Policy. This is also available on request.


    The resident in question has consented to this referral