Prior
to commencing this form, please ensure you have read the Accommodation Eligibility Criteria in full
Next of Kin
Doctor Information
Residential Status
Property Requirements
Expenditure
What other payments do you currently make? Please provide average monthly amounts in £ for all those that apply. Enter zero for those that do not apply.
Non-work related Income
Please
confirm how much of the following non-work related income (per month) and
savings you have. Enter zero for those that do not apply.
Rehabilitation of offenders Act 1974
Additional Notes
Equality & Diversity
Monitoring
Please help
us to check and ensure that we are making our independent living accommodation
schemes available to all eligible applicants by answering the following
questions.
Ethnicity Monitoring