Sanctuary Scheme Professional Referral form

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RISE is an independent, Brighton-based registered charity that helps people affected by domestic abuse. We offer practical help ranging from direct advice to housing support and accessing refuge accommodation.

The aim of the Sanctuary Scheme is to enable survivors of domestic abuse to remain in their home, maintain safe and secure housing, and prevent homelessness.

This is done by providing home security, and is part of BHCC’s response to the new duties contained within the Domestic Abuse Act 2021.

Sanctuary Scheme Professional Referral form

If you are looking to refer yourself into RISE services, please use the self-referral form

If you are a professional referring someone you are working with to all RISE services, please use the professionals referral form

Sanctuary Scheme Professional Referral form

Please do not proceed with this referral if the person you are working with is living with their alleged perpetrator, as they are not eligible for the Sanctuary Scheme

Please only proceed with the referral if the person you are working with meets the following criteria:

Safeguarding

Have you have assessed this person using DASH criteria?
I have assessed this person to be at:
Has this person been heard at MARAC?
GDPR and Consent
Date of Birth *
Client Address
Is it safe to (tick all that apply):
Client GP Address
Property Tenure:
Please tick which of the following applies:
Is there a Restraining Order, Non-Molestation Order, or Occupation Order in place? *

Suitability for The Sanctuary Scheme

Does the alleged perpetrator live at the property with the victim/survivor?

Because the person you are working with is still living with their alleged perpetrator, they are not eligible for support through the Sanctuary Scheme. Please do not proceed with this referral.

Is there a risk of arson?
Have you referred the client to East Sussex Fire and Rescue Service for an enhanced risk assessment?
Does the alleged perpetrator have a legal right to occupy the property?

To help us meet your client's needs, please give us some more details about them

Sex/Gender - tick all that apply
Sexual Orientation
Is your client okay communicating in English?
Does your client need an interpreter?

Does your client have any of the following accessibility requirements?

Tick all relevant boxes

Your clients ethnicity

White:
Black
Mixed Race/Multi Ethnic
Asian

Additional Support Needs:

Household details

Add a member of your household

Agency Involvement

Please give details of any agency the client is involved with currently (including the name of any workers and their contact details), e.g. Social Worker, Probation Officer, etc.
Please tick all that apply

Alleged perpetrator details

Name and any known aliases:
Date of birth:
Address:
Have the police taken any action against the alleged perpetrator?
Has the survivor/victim taken any action against the alleged perpetrator?
What do you think is required to help keep the person you are referring safer in their home?
If you have said yes to video doorbell, please confirm the following:
Do you want to receive a copy of this referral to your email inbox? *