YMCA

Accommodation Online Application Form

Fill out this form to apply for a place in our hostel.

Please be as honest as possible as this will help us to support you. If you need any help completing this form, call us or drop in to one of our hostels.

Fields marked with * are required.

Nottingham Hostel
4 Shakespeare Street
Nottingham
NG1 4FG
0115 956 7600
Mansfield & Ashfield Hostel
57 Commercial Gate
Mansfield
NG18 1EU
01623 407 801





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Support needs:

Please select all that apply:






























Current situation:







Have you experienced any problems in the following areas/or at risk of any of the following?

Risk low risk medium risk high risk
Mental Health Problems
Violence
Domestic Violence
Alcohol Abuse
Substance Misuse
Sexual Abuse
Crime Related Issues
Long Term Illness
Disabilities
Gambling
Other









Arson Drink/drug related
Sex offences Burglary
Violence/harassment Criminal damage
Weapons Offences against minors or the vulnerable














Minor injury Serious injury Death





















 

Are you involved in any activity with any support agencies?

 

Name of Worker

Address

Contact Number

Probation

Youth support

Drug services

Alcohol services

Mental health services

Outreach services

Floating support



















Are you on any of the following? Bail
Parole
Licence






Previous addresses

































































































Registered Charity 243044 | VAT 117 2061 10 | RSL H3286 | Registered Office 4 Shakespeare Street, Nottingham NG1 4FG
Company Limited by Guarantee, Registered in England and Wales-Registered 310342

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