Housing Application Form

This Application form can be used by Association Tenants wishing to apply for a transfer, by Waiting List Applicants wishing re-housing and for all applicants wishing to apply for consideration under the Lettings Initiative operated by the Association.

Please read the declaration on page 9 of this form before completing. Joint applicants must both check the declaration.

Please answer all questions and check boxes as required. The information you provide will be treated as STRICTLY CONFIDENTIAL.

The Association operates appointments and where possible we encourage applicants to attend the office to submit their application in order that we can provide applicants with information and a full assessment of their application.

1. Personal Details

APPLICANT
Surname:				Title (Mr, Mrs, Miss, Ms):
First names:				Date of birth:	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55
NI No:		Tenure:	Choose... c/o Friends c/o Parents SHA Tenant Tenant of other Landlord c/o Hostel Applicant has NTQ Owner Occupier	Date of entry:	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55
Address:				Flat position:
				Postcode:
Home tel:		Mobile:		Work tel:
Email:
Partner/Spouse
Surname:				Title (Mr, Mrs, Miss, Ms):
First names:				Date of birth:	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55
NI No:		Tenure:	Choose... c/o Friends c/o Parents SHA Tenant Tenant of other Landlord c/o Hostel Applicant has NTQ Owner Occupier	Date of entry:	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55
Address:				Flat position:
				Postcode:
Home tel:		Mobile:		Work tel:

2. Persons to be re-housed

Are you the only person to be re-housed? Yes No

Please enter details of all persons to be housed (including applicant). If just you, enter "N/A" in name box under applicant's*:
Full Name	Date of Birth	Relationship to Applicant	Do they live with you? (Check box if yes OR enter address)
		Applicant
*	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law UncleWife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife

3. Other Persons in household - who will not be re-housed with you

Enter the details of everyone else who lives with you. For each, enter full name, date of birth and relationship to applicant. If there is no-one enter "N/A" in the first box*:
Full Name	Date of Birth	Relationship to Applicant
*	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife
	--January February March April May June July August September October November December --01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  at  --00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : --00 05 10 15 20 25 30 35 40 45 50 55	Aunt Brother-in-law Brother Cousin Daughter-in-law Daughter Father Father-in-law Friend Grandmother Grandfather Grandchild Husband Landlord Landlady Mother-in-law Mother Neice Nephew Partner Other Sister-in-law Sister Son Son-in-law Uncle Wife

4. Previous Addresses

If you are a Shettleston Housing Association Tenant, please go to Question 5. All other applicants please give details of your last three addresses before moving to your present home.

Under the heading Tenure, we mean were you a tenant, living with parents, hostel resident, bedsit resident, owner occupier, living with relatives or friends, in supported accommodation or private let.

Current Address (provided above):	Landlord's name/address:
From:	Tenure: Choose... c/o Friends c/o Parents SHA Tenant Tenant of other Landlord c/o Hostel Applicant has NTQ Owner Occupier

Have you lived anywhere before this? Yes No

If you are currently living c/o parents, have you always lived within the parental home?

Yes No

5. Present Accommodation

THE HOUSE YOU LIVE IN

	What floor is it on?
	How many bedrooms are there?	0 1 2 3 4 5 6+
	How many of these are single bedrooms? (1 person)	0 1 2 3 4 5 6+
Amenities:	Check box if your house has the following amenities:
	Inside toilet	Separate kitchen
	Bath/shower	Kitchen facilities
	Hot water supply
Sharing amenities:	Check box if you have to share any of the following with another
	Toilet	Living room
	Bathroom/shower:	Bedroom
	Kitchen
Property amenities:	Check box if your house has any of the following:
	Internal kitchen (no windows):	Situated on ground floor, on main road and no garden:
	Poor windows (steel framed):
Dampness:	Check box if your house has the following:
	Rising/ penetrating dampness:
	We require report from Environmental Health Dept confirming dampness. Please note this may result in a notice being served on the property.

6. Other Housing Needs

MEDICAL

Do you, or any member of your household require to move for medical reasons? Yes No

CARE AND SUPPORT

Do you need to move house to be near a close relative or friend in order to either receive or provide care and support? Yes No

Mutual Exchange

Would you consider a Mutual Exchange? This is where two tenants agree to exchange houses with each other.

Are you interested in knowing more about this scheme? Yes No

7. Accommodation Requested

In this section we require you to indicate your choice of location and type of property you would be willing to consider. The Association will try to meet your housing choices, but in some instances will be limited in its ability to do so.

You should still indicate what your full range of choices are, in order that your interest can be registered.

Apartment size:	1apt	2apt	3apt
	4apt	5apt	6apt
Floor Height:	Any	Ground	1st
	2nd	3rd	Maindoor

Wheelchair Accommodation

Do you or a member of your household require accommodation that has been adapted to suit a wheelchair?

Yes No

Accommodation Requested

Are you interested in being considered for furnished accommodation?		Yes No
Are you interested in knowing more about buying a house from the Association on a Shared Ownership basis?		Yes No

Location

Please check your preferred locations for re-housing. You will only be considered for properties in locations you have ticked. When deciding on location please refer to our map.

Supply and demand can vary significantly across stock. If you are very restrictive it may affect your chances of re-housing.

Check all
1. Dalton Street new build
2. 578-660 Shettleston Road
3. 577-663 Shettleson Road
4. 3-15 St Mark St
5. Blair St
6. 40-88 Old Shettleston Road
7. 3-23 Ram St
8. 701-737 Shettleston Road/Fernan Street
9. Inter War Properties
10. 765-803 Shettleston Road
11. Kenmore Street (New build)
12. 885-901 Shettleston Road
13. 977 - 991/934-1154 Shettleston Road, Ardholm Street, Vesalius Street
14. 8-16 Meadowell Street
15. 1196 - 1392 Shettleston Road, 4 - 16 Academy Street, Killin Drive
16. 1145-1539 Shettleston Road
17. Budhill Avenue and Greenfield Place
18. Castlelaw Estate
19. Springboig Estate
20. Sandyhills Estate
21. Steel Estate
22. Amulree Street (New Build)
23. Glenalmond Street (New Build)
24. Pettigrew St / Wellshot Road / Orbiston Gardens / Sth Vesalius St / Denbrae St
25. Tollcross Mansionhouse
26. Anstruther St, Elvan St, Enterkin Street, Hillview St
26a. Edrom Path (Sheltered Housing Complex) - Over 60 only
27. South Shettleston
28. North Shettleston
29. South Greenfield

8. Local Letting Initiatives

Please check the relevant boxes if you wish to be considered for the lettings initiatives operated by the Association. An information leaflet is enclosed with this form.

Local Regeneration Lettings Initiatives – minimum age 25	Yes No
Steel Estate Elderly Lettings Initiative – minimum age 60	Yes No
Springboig Elderly Lettings Initiative – minimum age 60	Yes No

9. Reasons for application/additional information

Please provide details of your reasons for applying for housing. In particular, give details of any special circumstances or problems that you are experiencing which might be helped by re-housing and which are not covered elsewhere in this application.

10. Housing Scotland Act 2001

Are you or any member of your household, related to or otherwise connected with a member of the Management Committee or staff of the Association?

Yes No

Please note that this does not prevent you applying in the normal way, but does require that the Association must follow certain procedures laid down in Section 63, Schedule 7 of the Housing Scotland (Act) 2001.

11. Why do you wish to live in the Shettleston area?

12. Declaration

Please read the following carefully before submitting this application.

I/we certify that the information given in this application and any other application forms relating to this application is a true and accurate record of my/our present circumstances, if not the application/s may be invalidated and suspended from the “active” housing list.

The Association has the right to apply in court for repossession of any dwelling/accommodation where the tenancy was found to have been granted on false or misleading information.

I/we agree to inform the Association of any changes in my/our circumstances.

I/we understand that my/our application will be subject to an annual review and failure to respond to the review request sent by the Association will result in my/our application being removed from the register.

I/we authorise the Association to make any necessary enquiries or investigations to confirm the details of this application.

DATA PROTECTION

All information provided within this application will be treated in confidence and comply with the relevant Data Protection Act. The information within this form will need to be verified by any relevant party and in signing this form you give consent for this to be carried out and for third parties to release the required information. The purpose of obtaining this information is to verify your current and previous housing circumstances and the information will only be used for the purpose of assessing your re-housing need and requirements (The information will be held securely in our files and will be used for the purpose of assessing your housing need as defined in the Association’s Allocation Policy. Should you be successful in obtaining accommodation with the Association, this form and any additions/updates will be held securely in your house file). After the granting of any tenancy, should any of the information you provide on this application be found to be false or misleading, this will be grounds for the Association to raise action against you to end the tenancy.

I/we agree to the declarations above (check appropriate boxes below AND enter your initials in the appropriate box, e.g. JB):

	Applicant declaration. Initials:
	Partner declaration. Initials:

13. Ethnic Monitoring

Association is committed to the promotion of Equal Opportunities and as a result monitors all applications received to ensure that we do not directly or indirectly discriminate against disadvantaged groups and that our services reflect the needs of the population we serve.

To assist us in the process it is very important that the following questions are answered. However, if you choose not to answer any of these questions it will not affect your application or your right to our services.

HOW WOULD YOU DESCRIBE YOUR ETHNIC ORIGIN?

Ethnic origin:

Choose... White - Scottish White - Other British White - Irish White - Other (state below) Dual Heritage (Specify below) Asian, Asian Scottish, or Asian British - Indian Asian, Asian Scottihh, or Asian British - Pakistani Asian, Asian Scottish, or Asian British - Bangladeshi Asian, Asian Scottish, or Asian British - Chinese Asian - Other (e.g. Thai, define below:) Black, Black Scottsh, or Black British - Caribbean Black, Black Scottsh, or Black British - African Black - Other (define below) Any other ethnic background (define below)

Other ethnic background define:

HOW WOULD YOU DESCRIBE YOUR HOUSEHOLD?

Black/Minority Ethnic White Dual (e.g. Pakistani/Scottish)

DISABILITY MONITORING CATEGORIES

Do you consider yourself to have a disability as defined by the Disability Discrimination Act (DDA)?

Yes No

If YES, please check the appropriate box(es):
Mobility	Manual dexterity
Physical co-ordination	Ability to lift, carry or otherwise move everyday
Speech, hearing or eyesight	Perception or the risk of physical danger understand
Memory or ability to concentrate, learn or understand	Other (self-define below):

GENDER MONITORING CATEGORIES

How would you describe your gender?	Male Female Other (self-define below)
How would describe your household?	Choose... Single Male Single Female Couple (different gender) Couple (same gender) Single parent (male) Single parent (female) Family (different gender couple with children) Family (same gender couple with children) Other (self-define below)

AGE MONITORING CATEGORIES

16-25 26-40 41-50 51-60 61-75 over 75

LANGUAGE MONITORING CATEGORIES

Please state the language you prefer to use? e.g. English, Punjabi, Arabic, Sign, etc:

Thank you for your help to monitor our service.