Self-referral

The quickest way to get help is to complete the form below.
Or you can call our enquiries line on
0207 259 0801

Please note, this referral form should only be completed if you are referring yourself. By completing the form, this does not guarantee that Z2K will be able to take your case. Please read our referral guide.

We only accept referrals for people who live in London, are below pension age, and are in receipt of, or would be eligible for, a means-tested benefit. Can you please confirm that to the best of your knowledge:

You are resident in a London borough

You are in receipt of, or would be eligible for, a means-tested benefit

You are below pension age

First Name

Last Name

Tel

Address line 1

Address line 2

City

Postcode

Local Authority

Other local authority

Type of accommodation

Other type of accommodation

Name and ages of household members

Date of birth

National Insurance Number

Preferred contact method

How did you hear about us?

Communication requirements

Help with Universal Credit

If other please specify

Message - Universal Credit

Help with Employment and Support Allowance (ESA)

If other please specify

Message - ESA

Help with Personal Independence Payment (PIP)

If other please specify

Message - PIP

Help with Disability Living Allowance (DLA) for a child

If other please specify

Message - child disability

Housing benefit/Council tax

If other please specify

Message - Housing benefits/council tax

Housing Issues (Select all that apply)

No help required Preventing eviction, if you are currently facing eviction Problems with bailiffs Help with homelessness

Message - housing issues

Additional support

Need help or want to make a referral?

If you’re battling with housing, disability or welfare issues, there are many ways we could help you. Alternatively if someone you know needs our help you can refer them to us

Get support or refer someone

Your form has been submited

A member of the casework team will review your enquiry and get back to you within 5 working days.

Please check your junk mailbox if you haven't received a confirmation email.

Self-referral

The quickest way to get help is to complete the form below. Or you can call our enquiries line on 0207 259 0801

Please note, this referral form should only be completed if you are referring yourself. By completing the form, this does not guarantee that Z2K will be able to take your case. Please read our referral guide.

Need help or want to make a referral?

Get support or refer someone

Your form has been submited

The quickest way to get help is to complete the form below.
Or you can call our enquiries line on
0207 259 0801