Initial Referral Information

Please provide us with a few details before completing our housing application form. Please Note: All starred questions require an answer.

Person Completing the Form

Is the application for you or someone else?

For me Someone else

If For Me was selected, please go to Contact Details

If completing for someone else, please provide:

Your Name

Relationship to person

Who you work for (if applicable)

Now please complete the remainder of the form with the Young Person's details

Contact Details:

Name:*

Email Address

About You:

Sexual Orientation

Lesbian Gay Bisexual Heterosexual/Straight Other

Gender Identity*

Age*

Area of Origin (where you consider yourself to be from) eg Newcastle*

Ethnic Origin*

AfricanArabAsian BritishBangladeshiBlack BritishCaribbeanChineseIndianPakistaniWhite BritishWhite IrishAny mixed or other ethnic background

If other category was chosen, please specify

Is English your first language?

Yes No

If no, please state first language

About Us:

Why have you chosen to apply to Outpost?*

How did you find out about us?*

Why are you looking for housing? (N/A if you are not applying for accommodation)

Type of current accommodation eg hostel, living with parents*

Why do you want to live in Newcastle? (N/A if you are not applying for accommodation)