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Housing Application Form

Step 1 of 9

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  • You have expressed an interest in being considered for voluntary housing. This form is designed to provide us with information to assess the type of housing that will be best suited to your needs and to ensure you are provided support to maintain a tenancy should you require it.

    Please ensure that you fill out all relevant sections of the form and that the information you provide us is true and accurate. Withheld or false information may impact on your application for housing with Circle Voluntary Housing Association.

    Alternatively you can download, print and complete a PDF version of this form and post it back into us. Download Form.

     
  • Documents you need to prepare before starting this form:


    We will request you to upload these later in the form process

    ‣ Proof of identity

    A recent photo of drivers’ licence, passport, national age card issued by An Garda Síochána, public services card.

    ‣ Accessibility report

    Any supporting documentation relating to a requirement for specially adapted accommodation.

     
  • Section 1 - Applicant/s Details


  • Applicant 1

  • Date Format: DD slash MM slash YYYY



  • Applicant 2

  • Date Format: DD slash MM slash YYYY

  • Please upload a copy of drivers’ licence, passport, national age card issued by An Garda Síochána or public services card.
    Drop files here or
    Accepted file types: jpg, jpeg, png, pdf, .

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  • Section 2 - Housing History

  • We want to know about where you currently live and where you have lived to help us understand what type of accommodation best suits your needs.



  • Addresses might include a home you owned, a rented home, social housing or emergency accommodation.

    Address Type of Accommodation: From To Actions
           
    • Edit
    • Delete
    There are no Addresses.

    Maximum number of addresses reached.




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  • Section 3 - Accessibility

  • Please upload a Doctor's / Consultant's / Occupational Therapist's / Social Worker’s report in support of this application.
    Drop files here or
    Accepted file types: jpg, jpeg, png, pdf, .

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  • Section 4 - Household Details


  • Name Date of birth: Relationship Current Address Actions
           
    • Edit
    • Delete
    There are no Dependents.

    Maximum number of dependents reached.


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  • Section 5 - Support Needs

  • We want to make sure that you enjoy living in your new home and that you receive any relevant support. To do that we would like to know if you are currently receiving support, or need support in any of the following areas?

    • Current Family Relationships
    • Child Welfare
    • Legal issues
    • Income Finance
    • Physical Health
    • Mental/Emotional Health
    • Alcohol Use
    • Drug use
    • Other areas of support

  • Support Area Nature of support currently being received: Future support needs: Actions
         
    • Edit
    • Delete
    There are no Support Needs.

    Maximum number of support needs reached.


  • Support Worker name: Role and Organisation: Contact Number: Actions
         
    • Edit
    • Delete
    There are no Support Workers.

    Maximum number of support workers reached.


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  • Section 6 - Legal Issues/Offences

  • Type of conviction/investigation: Date it occurred: Actions
       
    • Edit
    • Delete
    There are no Legal Issues/Offences.

    Maximum number of legal issues/offences reached.


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  • Section 7 - Additional Information


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  • 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.

  • Date Format: 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.

  • Date Format: DD slash MM slash YYYY

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  • Section 9 - Check and submit your application

  • Please now use the 'previous' and 'next' buttons to check through your application to make sure that everything is correct and in place.

    When you are ready, please click the submit button below.

    Thank you for taking the time to submit the form.


Save and Continue Later


Need help or have questions about completing this form? Click here to contact us.


Tenant Assistance

  • Pre-Tenancy
    • Pre-Tenancy Questionnaire
    • Housing Application Form
  • Tenant care & responsibilities
  • Repairs and maintenance
    • Report a repair
  • Policies
  • Rent
    • Online rent payment
      • Payment failed
      • Payment successful
    • Contact Us
  • Service charges
  • Confidential Income Statement
  • Get involved in your local community
  • Pets
  • FAQs
  • Anti-social behaviour
  • Feedback and Complaints
  • Contact Us
    • Contact Us
Tenant Handbook
Contact Us
Report a Repair

Circle VHA, Phoenix House, 32-34 Castle Street, Dublin 2, Ireland.

Phone 01-4072110 Fax 01-4792356
©2021 Circle Voluntary Housing Association
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