Housing Application Form

Housing Application Form

Housing Application Form
1. Personal Details
  1. Title
  2. (required)
  3. Have you applied to SHAP before?
  4. Do you have any criminal convictions?
  5. NB: We ask this question so that we can properly assess your support needs. Please contact our Central Office on 01744 454056 if you would like to know more about why this information is required and how it will be used.
  6. Do you have children?
  7. Are you expecting a baby?
  8. Are you suffering from Harassment or Domestic Violence?
  9. Are you applying with anyone else?
  10. If yes, please complete:
2. Previous Addresses
  1. Please list all the addresses you have lived at for the last 5 years. Start with the address you live at now. We may use this information to get references from previous landlords.
  2. Do you have arrears from any property you have previously lived in?
  3. Have you ever been evicted?
3. Income Details
  1. Please tick the box that best describes you, and give full details below:
  2. If you are working/training, then please give the following details:
  3. Are you receiving benefit?
4. Present Housing
  1. Which of the following best describes your situation? Please tick one box for Occupancy and one box for Accommodation.
  2. Type of Occupancy
  3. Type of Accommodation
  4. Are you a tenant at your current home?
  5. If you pay rent or charges, please give the name and address of the person you pay:
5. Reasons why you need re-housing
  1. Please tick the boxes that best describe why you need re-housing.
  2. Is there a date by when you have to leave your current property?
  3. Where would you like to live?
  4. Knowsley
  5. St Helens
6. Support Needs
  1. SHAP provides supported housing which means that, as well as normal services such as rent collection and repairs, you will receive other services in order to help you manage and maintain your accommodation.
  2. Please tick the following boxes to indicate whether you have experienced, or think you may experience difficulties when living independently:
7. General Information
  1. Professional Support
  2. Do you have any professional support, such as a Social Worker, Probation Officer working with you?
  3. If yes, please give names and contact details:
  4. Disability
  5. Do you have any disability that requires particular arrangements or assistance?
  6. Are you a wheelchair user?
  7. Pets/Animals
  8. Do you wish to keep pets or animals at home?
  9. (Please note - we do not allow pets in some of our accommodation.)
  10. Are you employed by, or related to, any Committee Member or staff member of SHAP Ltd?
  11. Please read and sign the declaration below.
  12. As far as I know, the answers I have given on this form are true. I understand that I may lose any housing or tenancy if I have given false information. I understand that all the information given may be held on computer. I will inform SHAP Ltd if there is any change to the circumstances I have told you about on this form.
Equal Opportunities
  1. We are committed to fighting discrimination and inequality in our service to the public. To help us monitor the success of our Equal Opportunities Policy, it would be helpful if you could fill in the below fields. If you do not want to fill in this form, it will not affect your application. We will not pass on the information you give us to anyone else, and will only use it to monitor, develop and improve our housing policy. We will separate this form from your application before it is considered and it will not be part of the application process.
  2. 1. Ethnic Origin
  3. Guidelines: Ethnic Origin
  4. If you wish to classify yourself in some other way, please use the additional space provided to do so.
  5. I would describe my ethnic origin as (please tick)
  6. 2. Gender
  7. I am (please tick)
  8. 3. Age
  9. 4. Disability
  10. Guidelines: Disability
  11. We understand that many people do not declare disability because of possible discrimination against them by others, and many people do not register as disabled for the same reason. SHAP does not directly discriminate against disabled people but is aware that it is probably indirectly discriminating against them. We are striving to improve.
  12. a)
  13. b)
  14. c)
  15. 5. Sexual Orientation
  16. Guidelines: Sexual Orientation
  17. We appreciate that some people may find the question on sexual orientation to be an extremely personal one and we must therefore re-iterate that you are under no obligation to answer it. However, SHAP is particularly aware of discrimination against gay and lesbian people in housing and seeks to promote policies which actively work against such discrimination.
  18. I would describe myself as (please tick)
  19. 6. Comments
 

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