Organisation Referral | Kenneth & Jacob's House

Website

1 · Referring organisation

Organisation nameOrganisation typeReferrer nameRoleEmailPhoneRelationship to person

2 · Person profile — carries into admission

Full namePreferred name / aliasDate of birthNational ID / document numberPhoneEmailGender / identityPronounsSexual orientation (only if relevant/voluntarily shared)NationalityPreferred languageLegal/documentation statusEmergency contact nameEmergency contact phoneEmergency contact relationshipPrimary categoryProposed stay duration Survivor-related support is relevant to this referralDietary needsMedical information relevant to supportAccessibility needs Mental-health / psychosocial support may be neededKnown triggers, boundaries or safety preferencesAdmission goals / requested outcomesKnown case/history information

3 · Referral context & safety

Current / safe locationHousing / crisis contextImmediate safety concernsSupport requestedInitial urgency / risk

4 · Protected documents

ID document (mandatory)PDF/JPG/PNG/WebP, max 15 MB. Stored in protected SOIMS storage and viewable inline by authorised staff.Referral letter / other supporting documents I confirm this referral is lawful and I have shared only information necessary for KENJAC assessment, with the person’s knowledge/consent where appropriate.

Refer a person to KENJAC.