Refugees At Home

Please complete this form with as much information about your household and hosting preferences as possible. There is always an opportunity to discuss this further during your home visit or a member of the team.

First name

Last name

Email address

Telephone number

Alternative Telephone Number

Few days only

Less than a month

1 month

1 - 3 months

3 - 6 months

6 months or more

Willing to accommodate anyone

Single Woman

Single Man

Family with Children

Single Mother

Single Father

Couple

Referee 1

Referee 2

How did you hear about Refugees at Home?

Please specify where you heard about us

Anything else you would like to tell us at this point of your application?

In addition to email, what is your preferred contact method

Subscribe to newsletter?

I consent to the use of my personal data in accordance with Refugees at Home’s privacy policy

I agree that all the information provided is true and accurate

I confirm that I understand the scope of services being provided by Refugees at Home