Housing Application Form

Welcome

Are you registered with:

Have you applied to us before?

Your Details

Date of birth

Is there a joint applicant?

Joint Applicant Details

Date of birth

Your family or household

Please give details of all the people you want to be re-housed with you.

Do not include yourself or the joint applicant.

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Date of birth

Is this person living with you now?

Are any of the above people expecting a baby?

Please give details of anyone living with you who will not be moving with you.

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Where are you living now?

How many bedrooms are there?

Rent period

Do you receive help with rent from Housing Benefit?

Housing Benefit period

Do you receive help with rent from Universal Credit?

Universal Credit period

Which of the following do you live in?

Which floor is it on?

Do you have the use of a lift?

Are you?

Address history

If you have lived in at your present address for less than three years, please give details of your last two addresses:

Do you either lack or share any of the following amenities with anyone who will not be moving with you:

Bathroom

Inside toilet

Hot water supply

Kitchen

Living room

Does your present housing suffer from any of the following:

Reasons why you need re-housing

People apply to us for re-housing for many reasons. Please tick the boxes which best describe why you are applying:

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If you are homeless are you registered with the local authority housing options team?

Are there any other agencies involved (E. g. social workers, doctors)?

5. Health and Disability reason for re-housing

Do you or someone wishing to live with you suffer from a long standing illness or permanent disability which is affected by your present housing?

Does anyone to be re-housed use a wheelchair in the property?

Does anyone to be re-housed have difficulty climbing stairs?

Is anyone to be re-housed disabled?

Has your present home been adapted in any way for disabled use?

6. Where do you want to live?

We generally can only consider applications from people who have a connection with a village parish where we have properties.

Do you currently live in the above parish?

Have you lived in the above parish in the past?

Are you employed in the parish?

7. Income and Savings

Please give the total weekly amount of take home pay and/or pensions and benefits for yourself and any joint applicant. If none, please enter 0.

Joint Applicant

What is the total amount of savings to the nearest £1,000 that you and any joint applicant have in either a bank account, building society, post office or investment? If less than £1,000 enter 0.

Joint Applicant

8. Equal opportunities

CRHA will aim to help reduce the disadvantages that people experience by making our services more responsive to all communities and individual needs.

CRHA values the diversity of all communities and we want our services, facilities and resources to be accessible.

CRHA will from time to time collect information for equality monitoring. Details on how this information is used are available in CRHA’s Privacy Notice.

9. Statement

I declare that the information given on this form is true and accurate to the best of my belief. I under- stand that if a false statement is discovered after an offer of tenancy has been made the Association will commence legal proceedings for possession of the property.

I agree to provide any further relevant information as requested if it is reasonable and necessary to determine the application.

I authorise the Association to approach third party organisations such as employers, if necessary to do so. I understand that this does not affect my rights under the Data Protection Act 2018 or any subse- quent legislation.

I will advise the Association of any changes to my circumstances which could affect this application.

I do not object to the information on this form being used for statistical purposes provided that confidentiality is maintained.

Applicant signature (and joint applicant if applicable)

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