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TEST - South Lakes Housing

TEST

    Application Completed By:

    If you are completing this form on behalf of the applicant, please provide the following details;

    Name

    Contact Details

    Relation/Connection to Applicant

    By completing this section, I agree to allow South Lakes Housing to record my details further to the terms of the Privacy
    Policy.

    Overview

    Number of Applicants

    Number of other people in the household

     
    • Applicant 1

      Status *

      Full Name (Applicant one) *

      Gender *

      DOB *

      Mobile Number

      Landline

      Email Address *

      Contact Preference *

      Disabilities *

      NoneASD/AspergersBlind or Partially SightedDeaf or Hard of HearingHoarding TendanciesMental Health Difficulties Other Disability/Medical ConditionSpecific Learning DifficultyUnseen Disability (e.g. Epilepsy)Wheelchair or Mobility Difficulties

      Ethnicity *

      Nationality *

      National Insurance Num. *

      Employment Status *

      Is anyone in the household pregnant? *

      Any Sight, Hearing or Language Needs? *

      NoInterpreter NeededLarge FontBrailleBritish Sign Language User

      Has anyone in the household served in the Armed Services? *

      If anyone has served as a regular, did they leave in the last 5 years?

      Has anyone in the household been seriously injured as a direct result of their time in the armed services?

      Does anyone in the household use specialist equipment such as a Mobility Scooter, Oxygen, or anything else? Please state all items *

      What is the main reason for you leaving your last settled home? *

      Does anyone in the household require specialist access? *

      NoDisability RequirementsFull Wheelchair AccessWheelchair Access to Essential RoomLevel Access HousingOther Disability Requirements

      Is anyone in the household related to a SLH staff member? *

       
    • Applicant 2

      Status *

      Full Name (Applicant Two) *

      Gender *

      DOB *

      Mobile Number

      Landline *

      Email Address *

      Contact Preference *

      Disabilities *

      NoneASD/AspergersBlind or Partially SightedDeaf or Hard of HearingHoarding TendanciesMental Health Difficulties Other Disability/Medical ConditionSpecific Learning DifficultyUnseen Disability (e.g. Epilepsy)Wheelchair or Mobility Difficulties

      Ethnicity *

      Nationality *

      National Insurance Num. *

      Employment Status *

      Is anyone in the household pregnant?

      Any Sight, Hearing or Language Needs?

      NoInterpreter NeededLarge FontBrailleBritish Sign Language User

      Has anyone in the household served in the Armed Services? *

      If anyone has served as a regular, did they leave in the last 5 years?

      Has anyone in the household been seriously injured as a direct result of their time in the armed services?

      Does anyone in the household use specialist equipment such as a Mobility Scooter, Oxygen, or anything else? Please state all items *

      What is the main reason for you leaving your last settled home? *

      Does anyone in the household require specialist access? *

      NoDisability RequirementsFull Wheelchair AccessWheelchair Access to Essential RoomLevel Access HousingOther Disability Requirements

      Is anyone in the household related to a SLH staff member? *

       
    • Household Member 1

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status

       
    • Household Member 2

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status

       
    • Household Member 3

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status

       
    • Household Member 4

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status

       
    • Household Member 5

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status

       
    • Household Member 6

      Relationship to Applicant 1

      Status

      Full Name

      Gender

      DOB

      Employment Status