Housing Registration Form

Transcription

1 Glasgow Housing Association Registering for housing with us Housing Registration Form Section 1 Applicant contact details Applicant Title Mr Mrs Miss Ms First name Surname Maiden name Any other name you ve been known as Date of birth (dd/mm/yy) N.I. number Gender Male Female Address Contact address (if different from above) Telephone number Mobile number address Details of an emergency contact Address Telephone number Better homes, better lives

2 Section 2 Other people to be re-housed with you? Person (1) who will be living with you Is this a joint applicant? Relationship to you Date of birth (dd/mm/yy) Gender Male Female Is this person currently living with you? N.I number (only for people 16 or over) Person (2) who will be living with you Relationship to you Date of birth (dd/mm/yy) Gender Male Female Is this person currently living with you? N.I number (only for people 16 or over) Person (3) who will be living with you Relationship to you Date of birth (dd/mm/yy) Gender Male Female Is this person currently living with you? N.I number (only for people 16 or over) Person (4) who will be living with you Relationship to you Date of birth (dd/mm/yy) Gender Male Female Is this person currently living with you? N.I number (only for people 16 or over) Person (5) who will be living with you Relationship to you Date of birth (dd/mm/yy) Gender Male Female Is this person currently living with you? N.I number (only for people 16 or over) Page 2

3 Section 2 (continued) Other people to be re-housed with you? If they are not living with you now, please let us know why not and where they are living now. Person (1) Current address Reason for separation Person (2) Current address Reason for separation Person (3) Current address Reason for separation Person (4) Current address Reason for separation If anyone on your application is pregnant what is their name and when is the baby due? Person (1) Due date (dd/mm/yy) Person (2) Due date (dd/mm/yy) Page 3

4 Section 3 Address history Please list all addresses you have lived at for the last six years we may check and ask for references. Main applicant Address Were you known by any other name at this address? Date from (dd/mm/yy) Date to (dd/mm/yy) and address of landlord, or note if owner/occupied and (reason for leaving) Page 4

5 Section 3 Address history Please list all addresses you have lived at for the last six years we may check and ask for references. Joint applicant Address Were you known by any other name at this address? Date from (dd/mm/yy) Date to (dd/mm/yy) and address of landlord, or note if owner/occupied and (reason for leaving) Page 5

6 Section 4 Additional information This information will help us to work with you to assess any support you need to make sure you have every opportunity to successfully manage your tenancy with us. A. Are any of the people who are going to be living in the property on the Sex Offender Register? B. Is everyone on the application a UK National? If you answered, what is your country of origin? GHA will welcome applications for housing from individuals looking to live, work or study in the UK. All applications will be checked to ensure that all applicants detailed in the application: are not subject to immigration control have entitlement to a tenancy. n UK Nationals will be required to provide supporting documentation confirming their right to reside in the UK. C. Has anyone ever taken action against you, anyone else in your household, or anyone on your application for anti-social behaviour? If yes please give full name of person(s): Court action taken? Anti-Social Behaviour Order (ASBO) issued? Less formal action taken e.g. Verbal/Written Warning? D. Do you or any joint applicant have current or former tenant rent arrears with one of the partner landlords in Wheatley Group? Wheatley Group partner landlords include: Glasgow Housing Association, Cube Housing Association, West Lothian Housing Partnership, Loretto Housing Association, Barony Housing Association and Dunedin Canmore. If yes please give full name of person(s): Have you made arrangements to clear your debt? Are you maintaining the arrangement? Page 6

7 Section 5 Your circumstances A. Which of the following describes your current circumstances? Please tick one Cube tenant GHA tenant WLHP tenant Loretto tenant Dunedin Canmore tenant Barony tenant Council tenant (outside Glasgow) Tenant of private landlord Owner Lodger Staying with family/friends Homeless Other Housing Association fixed address Sheltered housing In supported accommodation Hospital Prison Residential care In HM Forces In housing tied to employment Other If Other please state: (if applicable, provide current landlord details) B. What type of home do you currently live in? Please tick one Tenement/flat Multi-storey House/semi-detached/terrace Four in a block upper flat Four in a block lower flat Deck access Hostel Hospital Residential Prison Sheltered housing Supported accommodation Caravan or similar Bedsit/studio flat fixed address Other If Other please state: C. Home assessment Has your home been assessed by local authority as below tolerable standard? If answered yes, please provide a copy of the Environmental Health assessment D. Bedrooms How many people are living at your current address? How many bedrooms in total are in the home you currently live in? How many of these bedrooms do the people included in this application have exclusive use of? Page 7

8 Section 6 Your needs A. Why are you applying for housing? (Please note your reasons, e.g. property is too large, too small, medical condition, move to another area) B. Do you or anyone who is going to be housed with you have any medical needs that would be helped by a move to another home? If yes, please complete an additional Health and Housing Need form. The form can be obtained from your local housing office, by contacting us on C. Do you require sheltered housing? If yes, please complete an additional Sheltered Housing application form. The form can be obtained from your local housing office, by contacting us on D. Do you need to move to be near family or relatives to provide or receive support? E. Do you or a family member need to move to be near a place of education? F. Do you require to be re-housed near your place of employment or a place where you do voluntary work for 16 hours per week or more? If yes, please complete an additional Community and Social Support application form. The form can be obtained from your local housing office, by contacting us on If you currently receive support from an organisation i.e. Social Services, health agency, voluntary organisation, please provide details below including name of organisation and name / contact number of your worker. Page 8

9 Section 7 Further information In the last 12 months have you or anyone related to you been an employee or a Committee member of one of our partner landlords? Wheatley Group partner landlords include: Glasgow Housing Association, Cube Housing Association, West Lothian Housing Partnership, Loretto Housing Association, Dunedin Canmore and Barony. If yes please give details of relationship below: Address Relationship Tenants with our partner landlords will be automatically registered for Home-swapper (Mutual exchange scheme), should you wish to opt out of the scheme, please tick this box Vacant properties are advertised every week at If you re unable to access the internet and wish to receive support to do this, please tick this box Section 8 Relevant details Please note below any other details that you feel may be relevant to your application: Each year, GHA, one of our partner landlords, holds local Community Housing Plan Forums to discuss and suggest letting ratios for the local Community Housing Plan Area for the following year. Would you be interested in participating in one of the local forums? Would you be interested in finding out how you can get more involved with one of our partner landlords and help shape their services? Page 9

10 Section 9 Declaration I / We hereby declare that the information given on this application form is, to the best of my / our knowledge and belief, accurate and truthful. I / We understand that if it is found that I / We have provided false or misleading information to the Associations, withhold information that is material to the application now and at any anytime, this may result in my / our application being cancelled and any offer of tenancy being withdrawn. Furthermore, I / we understand that participating landlords reserve the right to take legal action for the repossession of any tenancy granted on the basis of deliberately providing false information. In addition I / we understand that in circumstances of threatening behaviour or verbal or physical abuse aimed towards staff or committee members, participating landlords reserve the right to withdraw an offer of housing or suspend my / our application. I / We authorise the partner landlords to obtain information on any tenancy I / we have held and to take up references considered neccessary and relevant to this application. I / We understand that my / our home will be at risk if I / we do not keep up with rent payments. Main applicant Signature Date (dd/mm/yy) Joint applicant Signature Date (dd/mm/yy) If you become a tenant with one of our partner landlords your tenancy agreement requires you to pay your rent charge from day one when you get your keys. If you receive, or are entitled to receive, Housing Benefit this will be taken into account. If you are on Housing Benefit and your home is considered to have more bedrooms than you need under the UK Government s guidelines, you will be required to pay a proportion of the rent yourself. Your home will be at risk if you do not keep up with your rent payments. Data Protection Our partner landlords are registered under the Data Protection Act They are under an obligation to properly manage public funds. Accordingly information that you have provided on this form may be used to prevent and detect fraud and may also be shared for the same purpose with public bodies or other organisations which handle public funds. w you have completed the form you can send it back to us by clicking the submit button or ing it to register@gha.org.uk or if you re not online you can: hand it in to your local housing office send it to us at 25 Cochrane Street, Glasgow, G1 1HL. Interviewer Signature Date (dd/mm/yy) Page 10

11 Equal opportunities Under the Equality Act 2010, we must not discriminate against anybody because of their religion and belief when we provide services. To make sure we offer the same services and opportunities to all customers, no matter what their ethnic or racial background, faith or religion, we have included the following questions as part of our equal opportunities monitoring form. You do not have to fill in this form. If you do we will keep your information confidential and use it to create statistics only. It will not affect your application. Any personal details you provide will only be used to maintain your application and will not be used for any other purpose. 1. Please tick one of the ethnic groups shown to tell us your ethnic background White Scottish English Irish rthern Irish Welsh British Polish Other white background Any mixed background Black, black Scottish or black British African Caribbean Black Scottish/British Other black background Asian, Asian Scottish or Asian British Indian Pakistani Bangledeshi Chinese Other Asian background Other ethnic group Arab Gypsy or Traveller Multiple ethnic groups (do you consider yourself to be multi-racial): More than one ethnic group Does anyone in your household have a different ethnic background? I do not know If yes, please provide details: 2. What is your nationality? Please specify: 3. Please tick one of the boxes below to tell us your religion or belief. I am not religious Church of Scotland Roman Catholic Other Christian faith (please complete) Buddhist Muslim Hindu Pagan Jewish Sikh Another religion (please complete) 4. If you are an Asylum Seeker, been granted Refugee status or you are a migrant worker, please tell us by ticking the correct box below: (this information is for monitoring purposes only and will not prejudice your application for housing) Asylum Seeker Refugee Migrant worker Page 11

12 Equal opportunities (continued) 5. Domestic circumstances How would you describe your household composition? Single person Couple Single parent Couple with children 6. Disability We and our partner organisations wish to monitor applications from disabled persons. Under the terms of The Equalities Act 2010, disability is defined as: a person is disabled if they have a physical or mental impairment which has a substantial and long-term adverse effect on the individual s ability to carry out normal day-to-day activities. Do you or anyone in your household consider themselves to have a disability? What is the nature of your disability? Do you claim benefits for your disability? Your next steps We will be in touch shortly with your registration details. As soon as you receive these details you can start looking for a home and note an interest in your preferred properties. Thank you for registering with us. Page 12

13 Would you like more information? Scotland s largest social landlord with more than 39,000 homes to let in Glasgow. Call us on You can us at lettings@gha.org.uk or you can visit online at You can visit us at any of our local offices. To find the one nearest you, visit find-my-local-office Providing quality affordable homes across seven West of Scotland local authority areas. Call us on You can us at lettings@cubehousing.co.uk or you can visit online at Our address is Maryhill Burgh Halls 24 Gairbraid Avenue Glasgow G20 8YE Providing 5200 homes in Edinburgh, the Lothians and Fife. Call us on You can us at or you can visit online at Our address is 8 New Mart Road Edinburgh EH14 1RL Providing more than 1,000 affordable homes in the central belt. Call us on You can us at lettings@lorettoha.co.uk or you can visit online at Our address is 2nd floor, Lipton House 170 Crown Street Glasgow G5 9DX A leading East of Scotland social landlord with homes for rent in communities in West Lothian. Call us on You can us at lettings@wlhp.org or you can visit online at Our address is 62 rth Bridge Street Bathgate EH48 4PP Barony Housing Association has 360 affordable homes and provides care and support to over 700 people in Central Scotland. Call us on You can us at info@baronyha.org.uk or you can visit online at Visit your local office Go to baronyha.org.uk for a full list of offices

14 Office use only Date received (dd/mm/yy) Location received Local Housing Office Application reference number Housing debt check carried out? Housing debt outstanding? Income and Expenditure form completed? Application to be suspended? Reason for suspension: Community and Social (Group 4) priority awarded? Under assessment N/A Community Letting Area approved for CSS award Area: Sheltered Housing (Group 7) priority awarded? Under assessment N/A Medical priority awarded? Under assessment N/A If yes, was it Group 3 or Group 5 GHA tenants only Group 6 awarded N/A If noted as homeless, referral made to CCT? N/A If yes, date referred: Reason for decision for Group 3/4/5 award Housing Officer details Signature Date (dd/mm/yy) Page 14 GHAFA001/SEP17