Use this form to record client details when you must extend their stay past 12 weeks.
Client information (must be completed by the provider)
Client name	Click here to enter client name.
Date of birth	Click here to enter client’s date of birth.
MSD Client Number (if known)	Click here to enter client’s 9 digit client number.
Date client started in service	Click here to enter date client started in service.
Please provide details of why the client still requires emergency housing accommodation.
Please provide details of the steps the client has taken to find sustainable accommodation.
Has the client applied for social housing?
Has the client applied for a private rental?
Please detail any other steps the client has taken to obtain housing?
What support do you think would benefit the client to assist them in finding sustainable accommodation?