Housing Application Form

Step 1 of 9

Support Area	Nature of support currently being received:	Future support needs:	Actions

There are no Support Needs.

Support Worker name:	Role and Organisation:	Contact Number:	Actions

There are no Support Workers.

Type of conviction/investigation:	Date it occurred:	Actions

There are no Legal Issues/Offences.

Section 8 - Your Application Agreement
Please read the statements below carefully and check the relevant consent boxes.

To the best of my knowledge, all the information that I have given on this application form is accurate. I understand that if I have knowingly given inaccurate information my application may be refused.
Consent*
I/we agree to the statement above.
Your name:*
First Middle Last
Your name:
First Middle Last
Date*
DD slash MM slash YYYY
Sharing of information

Circle Voluntary Housing Association is collecting this information, so we can assess the type of housing that will be best suited to your needs.

To process your application, we will need to share the information you have supplied with your localauthority and other relevant services that you have identified on this form. This is to ensure you are safe in your home and to ensure we can support you to live in your home. We ask you to give consent to this.

Circle Voluntary Housing Association will follow the principles of the Data Protection Act and will make sure that the information you have provided is:
- Used fairly and legally.
- Only used for the purposes for which it was collected.
- Adequate, relevant and not excessive.
- Correct and up to date.
- Kept only for as long as needed.
- Processed in accordance with a person’s rights.
- Stored safely.
Your confidentiality is assured except when there is an issue around child safety; violence to yourself or others; the courts request a report, or you inform the worker of a criminal act you have committed or intend to commit.
Consent*
I agree to my information being shared by the services outlined above.
Your name:*
First Middle Last
Your name:
First Middle Last
Date*
DD slash MM slash YYYY

Save and Continue Later

Address	Type of Accommodation:	From	To	Actions

There are no Addresses.

Name	Date of birth:	Relationship	Current Address	Actions

There are no Dependents.

Step 1 of 9

Documents you need to prepare before starting this form:

‣ Proof of identity

‣ Accessibility report

Section 1 - Applicant/s Details

Applicant 1

Applicant 2

Section 2 - Housing History

Section 3 - Accessibility

Section 4 - Household Details

Section 5 - Support Needs

Section 6 - Legal Issues/Offences

Section 7 - Additional Information

Section 8 - Your Application Agreement

Sharing of information

Section 9 - Check and submit your application

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