Apply to host - Hope at Home - A Hosting Scheme for Survivors of Slavery

Application Form

Begin your hosting journey here. If you have any questions, concerns or issues with completing this form, please contact us at info@hopeathome.org.uk and we'll be in touch as soon as possible.

Your household

Please provide the full names, dates of birth and ethnic origin of everyone living in your home, including children. (Please note, ethnic origin information is for our monitoring purposes only):

Name: *

Date of birth: *

Ethnic origin:

Name:

Date of birth:

Ethnic origin:

Name:

Date of birth:

Ethnic origin:

Name:

Date of birth:

Ethnic origin:

Name:

Date of birth:

Ethnic origin:

Home address: *

Contact number(s): *

Email address: *

Languages spoken in order of fluency: *

Assuming compatibility with the guest and your availability, how long are you prepared to host for? *

Three to six months
Six to twelve months
More than twelve months

Please note, we will be regularly reviewing the placement and will review initially after one week and then one month. (Please tick all that apply).

Will the guest have sole use of their own bedroom?: *

Yes
No
Other (please specify)

If other, please detail:

Please outline local amenities and their proximity (e.g. doctor's surgery, shops, library etc.): *

Is there a burglar alarm?: *

Do you have any pets?: *

Are there any health issues or disabilities within your household that need to be considered?: *

Is everyone in your household happy with the idea of hosting? Are there any issues we need to be aware of?: *

Do guests need to be aware of any cultural or religious practices in your household?: *

Are you happy to host a guest of any religion and none, and for them to be able to practice their faith in your home? (For example, praying in their room): *

What is your current occupation?: *

What are your leisure activities and interests? (This helps with our matching process.): *

Please tell us why you are interested in hosting and whether you have any previous experience of hosting / voluntary work?: *

References

Please provide the names and contact details of two referees. One must be someone who has known you for over two years and the other must be someone who has known you recently in an employment / voluntary capacity. Please note, referees must not be family/household members.

Name: *

Address: *

Phone: *

Email: *

Relationship to you: *

How did you hear about Hope at Home?: *

Data Protection & Consent

We value your support and promise to respect your privacy. The data we gather is managed in accordance with the Data Protection Act 2018. We will not disclose or share personal information without your consent. I give Hope at Home my consent to carry out checks with the Disclosure and Barring Service (DBS) and to contact two personal referees. I also give consent for Hope at Home to store my personal application information for the purpose of the administration of the scheme. By signing this form, I am confirming that I have read the attached Data Privacy Notice and that am consenting to Hope at Home holding and processing my personal data for the following purposes (please tick the boxes where you are happy to grant consent):

I consent for Hope at Home to:

To process my volunteer application
To maintain regular supervisory support (e.g. contact me to see how volunteering is going, inform me of client change in circumstances)
To inform me of news, events, activities or services running from Hope at Home, including supervision and training sessions
All of the above

You can grant consent to all the purposes; one of the purposes or none of the purposes.

Methods of contact:

You can grant consent to all the methods; one of the methods or none of the methods.

Where you do not grant consent, we will not be able to use your personal data except in certain limited situations, such as where required to do so by law or to protect yourself or members of the public from serious harm.
If you do grant consent, please note you can withdraw your consent to all or any one of the above purposes at any time by contacting Hope at Home (info@hopeathome.org.uk)and requesting this in writing.
Please note that all processing of your personal data will cease once you have withdrawn consent (unless there are safeguarding/legal reasons preventing this) but this will not affect any personal data that has already been processed prior to this point.
Please also note that we also require all volunteers to have undertaken an enhanced DBS Check with barring information before starting to host.

Signatures

Names and signatures of all those over the age of 18 living in the home:

Print name: *

Print name:

Signature *

Clear Signature

Signature

Clear Signature

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Your household

References

Data Protection & Consent

Signatures

info@hopeathome.org.uk

Tel: 07923 246561

Placement/Referral Enquiries: 07842 416299 | 07566 778366