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Are you eligible?

Using this form you can apply to join our waiting list for housing.

In order to join our waiting list you will have to meet certain eligibility criteria. If you meet these you will be able to proceed to the second stage of the application.

If you do not meet our eligibility criteria, sorry, but you will not be able to proceed to the second stage. If you have any questions or problems filling this form contact Crown Simmons.

If you are eligible you will need to provide the following information, please make sure you have it to hand before you begin your application:

• your National Insurance number
• details of your addresses over the last three years, together with the contact details of your current and past landlord (s)
• details of all your sources of income, including any savings or investments
• details of any medical conditions which might affect your need for housing

Please make sure you have a digital copy (that you can attach with your form) of the following information:

• clear photo of yourself (and your joint applicant if applicable)
• any supporting evidence of your need for re-housing (for example e-mails/letters to your landlord, or court orders following complaints of harassment, etc.)
• a 'Notice to Quit' from your landlord (if applicable)
• a letter from the home-owner or main tenant if you have been asked to leave your home
• Estate Agent's Valuation (if applicable)
• Mortgage Statement (if applicable)

If you wish to submit a joint application we will need details for both applicants.

All information given on this form is treated in strict confidence.

You will be asked to provide evidence of the steps you have taken to resolve the problem and the outcome, e.g. letters to landlord, injunctions, etc.

Keeping animals may not be possible in certain types of accommodation or locations (e.g. keeping a dog where there is no access to a private garden), applicants will need Crown Simmons Housing’s written consent if they wish to keep a pet in any housing that may be offered.

Applicant 1 Employment details (if applicable)

Applicant 1 - State Benefit Details

Applicants 1 - Other Income and Savings

Applicant 2 Employment details (if applicable)

Applicant 2 - State Benefit Details

Applicants 2 - Other Income and Savings

Type of housing required (Tick all that apply)

Medical Professional’s Details

Please give details of the medical professionals that deal with you or any of the persons included in this application for housing’s medical condition or disability as the Association’s Allocation Panel may need to contact them.

Consent to Contact Medical Professionals

This section must be signed by the person(s) with or the legal guardian(s) of the person(s) medical condition/disability for us to consider your application on medical grounds.

I/We give permission for the Association’s Allocation Panel to contact the above medical professionals for further information about the health problem and/or disability I/We have described.

Crown Simmons Housing operates policies designed to ensure that all applicants receive equal treatment regardless of race, colour, origin, age, sex, sexual orientation, religion or disability. To ensure that this policy is carried out, we monitor those who apply to us for housing. To help us do this, we are inviting you to provide information on your ethnic origin. Should you not wish to do so, your application will still be given fair consideration. This information will not be used by those involved in selection and is for statistical purposes only. It will be separated from your application and treated as confidential.

Data Protection Act 1998

Some of the information on this form is likely to be collated and used for statistical purposes only; all personal details supplied will be used in confidence.

For independent advice about data protection, privacy, and data sharing issues contact the Information Commissioner at:

ico.org.uk
casework@ico.org.uk
0303 123 1113 (local rate)
01625 545 745 (national rate)
Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF