Northamptonshire Housing Self-Referral Form

Our accommodation is located in Northampton, Wellingborough, Kettering, Rushden, Corby and Daventry.

If you have any questions about completing this form please contact us at referrals.northants@changing-lives.org.uk.

Our Commitment

We will process the referral application in a fair, open and transparent way. We will at all times work to our policy on equality and diversity. If you are unhappy with any aspect of the process please don’t hesitate to tell us.
We will treat all private and sensitive information received as part of the referral process in a highly professional and respectful way and in line with General Data Protection Regulation 2018.
We commit to processing the referral efficiently and promptly.

Your Commitment

I confirm that, to the best of my knowledge, the information contained within this form is accurate.
Please complete all details below, add as much information as you wish, then sign the form. (Note: if form is not signed, referral cannot be processed.)

Agency Referrals

If you need to make a referral on behalf of a client, please download the Agency Referral form here and email it to referrals.northants@changing-lives.org.uk.










    (If none, we can help you obtain some)


    Equal Opportunities

    This information is confidential, but essential, to enable us to meet criteria such as compatibility 
within shared accommodation & accessibility.

    Is your gender the same as you were assigned at birth?






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