Guest Application Form

Sanctuary Hosting is a scheme that matches hosts (people who volunteer a spare room that they provide rent-free on a temporary basis) with guests (sanctuary seekers who are homeless, or about to be, and have come from another country).  Please note that we are not a housing service and cannot find self-contained accommodation for people.

By filling in this form you are saying you want to be a guest, and stay with a host. There are notes and explanations in green (like this!) to help you fill it in. If you don’t speak or write English very well, please try to ask someone to help you fill out the form. 

We are sorry to be asking you lots of questions as we know you have probably already been asked them by many other people, but we are doing it because we want to help if we can. It really helps if you are completely honest with your answers. 

To be considered as a possible guest you (and any others you are applying with) need to be:

●	Either homeless or about to be homeless.
●	From another country and with a strong reason for not wanting to go back to your country. This should not be an economic reason. 
●	18 or over (we don’t house children).
●	Without an alcohol or drug problem. 
●	Without a history of being violent.
●	Without any criminal convictions (this does not include immigration offences)
●	Without a serious mental health condition (if that makes it hard for others to live with you). 
●	Willing to accept any reasonable accommodation that is offered to you, including Home Office accommodation.
●	For survivors of Domestic Abuse, willing to provide a completed safety plan.
●	Honest about any health symptoms you, and those you have lived with, have so we can house you safely, with specific reference to COVID 19.

Please confirm that you satisfy all those conditions.         YES      NO

If ‘Yes’, please continue to complete this form.

If you have selected ‘No’ then unfortunately you don’t meet our criteria and there is no point in applying to us, though we wish you well.

If you are making this referral on behalf of someone else, please give your name and organisation (if relevant)

…………………………………	(name)

………………………………..	(organisation)

1.	Date of application     ……………………………………………………………………

2.	Information about the person wanting hosting

First name …………………………..    	 Last name ……………………………………..           
(this is the main applicant – if you want to be housed with others there is space for them under no. 3) 

Known as……………………………………    Male/Female………………………………

Date of Birth:     /    /      (if known)  or approximate age………			

Religion (if any) …………………………… 

Mobile number ……………………………	Any other contact number ……………………………………

Email ………………………………………………  (please write clearly)

Your country of origin ……………………………………………………. (we take people from many countries) 

Your ethnic background …………………………….

Date of arrival in the UK ......................................  	

Do you have permission to be in this country?      YES    NO
(We can take people who don’t yet have permission)

What is your legal ‘status’ in this country ?
This helps to give us an idea of how long you might need accommodation for. We take people from all the categories below. 

Please choose the one that applies:

Refugee          Asylum Seeker           Refused asylum seeker           Going to apply for asylum 	

Other (please specify) ………….

Do you have to sign with the Home Office?     YES      NO

If ‘Yes’, please say how often you sign, and where: ……………………………
           	
3.	Do several of you want hosting together?     YES    NO     (if ‘No’ go to question 4)

If ‘Yes’, please tell us about the others
Name of person	Date of birth	M/F	Relationship to you	

	

If we cannot house you together would you be willing to be housed separately?      YES   NO

4.	Current housing situation

Where are you living at the moment?
(If you are street homeless, please say where you are sleeping. Otherwise please give the address where you are staying at the moment)

………………………………………………

How long have you been there? ....................................

How long can you stay there? .....................................

What is the arrangement and why do you need to leave it? …………………..

Can we contact the house-owner?      YES   NO

If ‘Yes’, please give us their name and phone number ………………………………

If ‘No’, please say why ………………………………………

If you are an Asylum Seeker have you applied for Home Office accommodation     YES   NO

If ‘No’, please state reasons ………………………………………

5.	Questions about money

The hosting scheme is completely free. However, it helps us to help you if we understand your financial situation.

Do you have permission to work?   YES    NO

If ‘Yes’ do you have a job     YES    NO  

Do you get benefits?     YES     NO
 If ‘Yes’, please give brief details ................................................

Do you get asylum support money?     YES    NO
If ‘Yes’ how much per week?     £

Please specify any other amounts of money you are receiving:

Where from? Eg name of agency	What is the money for?	How much per week on average?	

			

6.	Next of kin

Who would you like us to contact if anything happened to you – for example, if you had to go to hospital? 

Name	Relationship to you	Address	Telephone number	

7.	Questions about health and wellbeing

a)	Are you registered with a GP?    YES    NO

If yes, please give address of GP/Health centre ……………………………………………………..

b)	Do you have a disability?    YES    NO
 
c)	Do you have any of the following conditions: 
Depression		YES    NO		Heart Condition	              YES    NO
HIV / AIDS		YES    NO		Mental Health Issues	     	YES    NO
Hepatitis		YES    NO               	Chest or similar condition    	YES    NO
Kidney condition	YES    NO		Other serious conditions 	YES    NO

If you have answered YES to any of these, please give brief details ……………
Do you take any medication? YES    NO

If YES please give brief details .……………………………………

d)	Do you have any condition that requires you to have injections?     YES    NO

If YES please give details ………………………………………………………………………………….

e)	Do you sometimes self-harm or struggle with suicidal feelings?     YES    NO 
If YES please tell us a little more  
……………………………………………………

f)	Do you sometimes have problems dealing with angry feelings?    YES    NO
If YES, please tell us a little more, including whether you have any history of violent behaviour

………………………………………………………………………………………………………

g)	Do you have a criminal record?   YES    NO
If YES, please give brief details ……………………………………………………………
(Minor offences do not always mean you cannot be accepted onto the scheme. However, please note that Sanctuary Hosting reserves the right to check with the authorities that information provided is correct and if you have failed to disclose information fully then you will be excluded from the scheme.) 

h)	Do you have a drug or alcohol dependence or any history of this?  YES    NO

………………………………………………………………………………………………………

i)	If there is any other information that we might need to know about your health, please give details

…………………………………………………………………………………………………………………………

8.	Other agency involvement

Solicitor’s name ……………………………………………………………………………

Name and address of practice ……………………………………………………..

…………………………………………………………………………………………….

Phone number …………………………………………………………………

Please list any other agencies involved (other than referrer):

Name	Agency	Contact details (phone/email)	

			

			

9.	Questions to help us match you with a host 

a)	Do you mind being placed in a household with pets?    YES    NO

If YES, please identify the type of pet you would find difficult and why. 
(We ask this because some hosts have pets such as a dog or cat)
……………………………………………

b)	Do you have any allergies     YES    NO

If ‘Yes’ please give details ……………………………………………………………………………

c)	Do you have any particular dietary needs?    YES    NO 

If YES please give details eg halal, diabetic 
……………………………………………………………

d)	What languages do you speak and how fluently?  1 = good, 2 = moderate, 3 = basic

1.	………………………………………  1    2    3
 
2.	………………………………………  1    2    3

3.	………………………………………  1    2    3

If you speak little or no English, do you know anyone who can interpret for you? 

Name …………………...…………………………….….

Phone number ………………………………Email ……………………..………….….

e)	Preferences: 

In a hosting situation would you prefer to: 

Interact a lot    ……………………………….……………………………….…………. Interact only as much as needed 
(please mark a point on the dotted line with an X) 

Live as part of the family ……………………………….…………………………………………… be more independent 
(please mark a point on the dotted line with an X) 

f)	What are your interests and hobbies? How do you like to spend your time? Please give as much information as you like, as this helps us to match you with the best host for you.
For instance, do you like gardening / being with children / cooking / walking / reading / studying (if so, what) / playing games or sports? / do you follow any teams?

…………………………………………………………………………………………………………………………………

g)	Please give us a rough idea of how many personal belongings you would need to bring - for example, how many carrier bags or suitcases

………………………………………………………

h)	Do you want to be in or near a particular area eg Oxford, Milton Keynes or Reading    YES    NO

If YES please say which area, and why you want to be there

………………………………………………………………………………………….

i)	Are you willing to be hosted outside a city (some hosts live in the countryside)?   YES    NO
If NO, please say why (the more flexible you can be, the more chance we have of offering you something) 

…………………………………………………………………………………………. 

j)	Finally, if you would like, please tell us briefly why you needed to leave your home country and why you can’t go back.
…………………………………………………………………………………………………………………………………

10.	Referees
People on the hosting scheme are offered a room, on a temporary basis, in a private home. You will therefore understand that we need to do some checks before we offer you a room. (We also do checks on the hosts.)
Please give us the names and contact details of two people who can provide a reference for you. These should be people who know you in a professional capacity; for example, a solicitor, someone from a charity or other organisation, a doctor or other healthcare worker, or teacher. If you are not sure whose name to give, please ask us. 

Details of referees: 
1 Name ……………………….
   Email ……………………….
   Phone ……………………..
   In what capacity does this person know you?  ……………………………..
 
2 Name ……………………….
   Email ……………………….
   Phone ……………………..
   In what capacity does this person know you?  ……………………………..

Thank you. Please now go to the end of this form, read the Notes for Applicants, and sign and date the form. 

11.	Questions for Referrer 
(If someone else is working with you to fill in this form, they should complete this section)

Full name of referrer ……………………………………………………….. 

Agency (if any) that you work for……………………………………………………

Your role within the organisation …………………………………………………….

How long have you known the applicant?..............................................

In what capacity do you know them?.............................................

Your contact details:
Email …………….
Phone 	1 ………………………… (mobile)
2 ………………………… (work)

We ask the referring agency to take overall responsibility for supporting the guest including helping them eventually find accommodation so that they can leave the hosting scheme. 
Are you able to make this commitment?     YES    NO

Please describe what ongoing support your organisation will provide for the applicant? 

…………………………………………………………………………………………………………………………………

How often can you arrange to see them (we need a regular commitment)?

…………………………………………………………………………………………………………………………………

Are you aware of any reason why the applicant should not be placed in a household with children?   
YES   NO 		 If YES please give reasons

…………………………………………………………………………………………………………………………………

The hosting scheme places guests in private homes. Are you aware of any other factors that might be of relevance to a safe placement and that have not been mentioned above?     YES    NO
If ‘Yes’ please specify
…………………………………………………………………………………………………………………………………

Please add anything else you think we should know and your own thoughts about how hosting may help this person 
…………………………………………………………………………………………………………………………………

Notes for referrer:  While we respect client confidentiality policies, we cannot accept referrals from agencies that withhold information which we believe could lead to a host or member of their household being placed at risk.  It is important that you, as a referrer, disclose all information that might possibly be relevant to the success of the application and not try to make the situation, details about or circumstances of the applicant appear better than they are.

I have read the above and confirm that I have relayed all relevant information fully and accurately. I also confirm that the organisation I represent will continue to actively pursue accommodation for this person while they are hosted (if they are) so that any hosting provided can be brought to a timely end.

Signature of referrer/person completing form (electronic signature acceptable): ………………………………………..
Date:      /    /    
Organisation:   …………………………………………..

Notes for applicant: By signing, you give consent for information contained in this form to be shared within the Sanctuary Hosting scheme, and with the host/s with whom you may be accommodated. You are also agreeing to Sanctuary Hosting undertaking a check to see if you have any criminal record and for any of those people referred to on this form to be contacted.

You are also signing that you understand that any hosting offered to you can only be on a short term basis and that once one arrangement with a host comes to an end there is no guarantee that Sanctuary Hosting will be able to find another host. Being a guest with a host does not give you any rights of tenancy and can come to an end at any time without a reason having to be given. Please note that Sanctuary Hosting reserves the right to refuse guests who present unreasonable behaviour.

I have understood the above and confirm agreement

Signature of applicant (electronic signature acceptable):   …………………………………………..
Date:      /    /    

Thank you for filling in this form. We will contact you as soon as we can to let you know the outcome. 

This form can be sent by email to info@sanctuaryhosting.org 

Or by post to Sanctuary Hosting c/o Emmaus Oxford, 171 Oxford Road, Oxford OX42ES

Privacy Notice: All personal information collected, stored and used by Sanctuary Hosting will be held within the provisions of the General Data Protection Regulation 2018. Sanctuary Hosting collects and uses your personal information to advance our charitable objectives and to assist us in monitoring and improving what we do. More specifically, we collect and use your personal information to match hosts to potential guests, to manage the hosting process, to keep supporters and donors informed, and to comply with our legal obligations. We do not share personal information with third parties except where it is necessary in order to carry out our charitable objectives or comply with our legal obligations. For our full privacy policy please email info@sanctuaryhosting.org.uk to request a copy.