Referring Others

Please use the form below to refer new clients to the foodbank. Once you have completed and submitted the form, please ask the client to contact the foodbank using the contact details shown above.

Referral Agency *

Referrer's Name *

First

Last

Referrer's Email Address *

Client's Full Name *

First

Last

Client's Telephone Number *

Client's Home Address *

Client's Email Address

How many adults (18 or over) in the household? *

How many children (under 18) in the household? *

Is the client or anyone in the household currently employed? *Full-TimePart-TimeNo

Current or Previous Occupation

For statistical analysis please provide the person’s current occupation, or if they are currently unemployed, their occupation when they last worked

Housing Situation *Home OwnerRentingHomelessOther

What is the cause of the crisis? (tick all that apply) *

• No Income
• Low Income
• Refugee
• Universal Credit Delay
• Universal Credit Cut
• Debt
• Illness
• Domestic Violence
• Other (please type reason in box below)

If you ticked Other above, please a description here

Permission *

• Please tick to confirm that the person being referred has given their permmision for this form to be sent and for their data to be used by Crediton Foodbank. Data from the referral will be kept on a secure database, used for monitoring purposes and for statistical analysis for which data is anonymized. Your data is not used for any other purposes and is only seen by people that need to for foodbank reasons. Details are never sold or given to any other body. Under data protection legislation the foodbank has to have lawful grounds to hold your data, and this comes under ‘legitimate interest’. i.e. it is reasonable (‘legitimate’) that the foodbank use data in the way described if it is to operate as people would expect. To know more about why we keep your data, what we use it for, how we keep it safe and your rights please speak to the Foodbank Coordinator

Submit