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Guardian Light Foundation – Counselling Support Referral Form

Guardian Light Foundation – Counselling Support Referral Form

This form is for professionals referring individuals or families who are homeless, at risk of homelessness, or in crisis.


Our Counselling Support (Tier 1) offers free, trauma-informed sessions for children, teenagers, and struggling single parents.

Referrer Information

(To be completed by Council / GP / Social Worker / Partner Organisation)

Preferred Contact Method (Email / Phone)

Client Details

Birthday
Day
Month
Year
Gender

Reason for Referral

What is the main reason for referring this client? (Select all that apply)

Support Requested

Type of Counselling Support Requested:
Has the client received counselling before?
Is the client currently receiving support from another agency?

Consent & Declaration

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Date
Day
Month
Year

Supporting Evidence

(Optional but helps speed up review)

Upload or attach any relevant evidence:

  • Eviction letter or housing letter

  • Letter of support from a local authority

  • GP or social worker statement

  • Safeguarding or risk assessment

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