| Your Details |
| Full Name: |
|
| Date
of Birth: |
|
| Age: |
|
| Address1: |
|
| Address2: |
|
| Town: |
|
| Post
Code: |
|
| Contact No: |
|
| National Insurance No: |
|
| How
long have you lived at this address? |
|
| Is
this accommodation: |
Parents Home |
Housing Assoc. |
| |
Private Rented |
Council
|
| |
B & B |
Friends
Home |
| Details of any other addresses you have lived at during the
last two years. |
|
| Why do
you need accommodation? |
|
| Is
there anybody you wish to be re-housed with? |
|
| Do you
require female only accommodation? |
Yes |
No
|
| |
|
| Community Campus provides a wide range of support -
what help do you think you will need if you were to leave your
present accommodation? |
|
|
| |
|
Do you
recieve any support from other agencies?
e.g. Probation, Social
Services etc. |
Yes |
No |
|
If yes please ask for a supporting letter to submit with
this application |
| Name
of Worker |
|
| Agency |
|
|
If No can you ask a youth worker / teacher or somebody
who knows you for a supporting letter. |
| |
|
|
| |
|
|
|
Are you - |
Employed |
Recieving
Benefits |
| |
In Education |
In Training |
| |
|
| Do you
have any health problems / disability? |
|
| Where,
or from whom did you hear about Community Campus? |
|
| |
|
| |
|
| Declaration |
|
| |
|
| I
understand that this application from does not constitute an offer
of accommodation. To the best of my knowledge this information is
true and accurate. |
Name
|
Date
|
| |
|
| Equal Oppotunities Monitoring Form |
|
| |
|
Community Campus
Housing Co-operative aims to make sure that all applicants are
treated equally regardless of their origin, gender or
disability.
In order to monitor this policy we would be
grateful if you could complete the details below.
All information
will be treated in the strictest
confidence.
|
|
I am
|
Male |
Female |
|
I would describe myself as |
Disabled |
Registered
Disabled |
| |
White |
Black |
| |
European |
Asian |
| |
African |
Caribbean
|
| |
Other |
|
| |
|
| |
|
| |
|
|
|
|
