Homelessness advice form

In order to get advice, please fill in the form below. Please complete ALL parts of the form. If a part of the form does not apply to you or you are unsure of an answer, you must still fill it in with "not applicable" or similar

Your Full Name:
Your Email Address:
Your Postal Address
A Contact Phone Number
Who lives in your household
Are you subject to immigration control, or have you previously returned to the UK after living abroad?
Where are you living now?
Why do you need to leave your current accommodation? When?
Is anyone in the household pregnant?
Are you homeless due to an emergency e.g. fire, flood?
Is anyone in the household vulnerable because of old age disability or other reason?
Why did you leave your previous accommodations?
Which local authority do you want to apply to and why?
Provide a description of the problem and what has led up to the situation and what outcome is wanted.