TO: Housing Welfare/Social Work Section,

Dublin City Council,

Civic Offices, Block 1, Floor 2, Christchurch,

Dublin 8

Tel: [phone] Fax [phone]

HOUSING WELFARE/SOCIAL WORK SECTION REFERRAL FORM

Referral for attention of Principal Social Workers:

Patricia Sweeney (Team A) ;

Doone Taylor/ Eithne O'Donnell (Team B) ;

Catherine Redmond (Team C);

Anne Helferty (Travellers Team) (see footnotes below)

John Hanley

Name of Client:…………………………………………………………………..

……………………………………………………………………………………..

Address of Client………………………………………………………………..

………………………………………………………………………………………

…………………………………………………………………………………………

Former address (if known)……………………………………………………………

……………………………………………………………………………………..

Phone contact number for client (if any)

......................................................................

Date of Birth: ­­­­­­­­­­­__________ PPS No: ­­­­­­­­­­­­­­­­­­______________

Is this referral specifically for tenancy sustainment? Yes/No If Yes, for what reasons?

Is client/ tenant aware of referral? Yes/No/ I don't know

All clients/tenants should be made aware of referral if possible

Main problem/ issue, as described by the client:

Name of person making referral:

Title :

Office:

Phone:

Date of referral: / /

What this referral can hopefully achieve:

Other contact persons or agencies:

Additional Comments/Information, if any, by person making the referral:

Team A covers the Ballymun, Finglas and Ballyfermot areas

Team B covers the Crumlin, Inchicore/ Kilmainham, South Inner City, South

East area and North West Inner City

Team C covers the North Central and North East Inner City

Travellers Team covers members of the Travelling community

Housing Welfare Referral Form revised Nov 2013.doc Page 1 of 2

Team A

Team B

Team C

Travellers

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