Applicant Form

Retrieve Existing Application

Prior to commencing this form, please ensure you have read the Accommodation Eligibility Criteria in full

Under which Housing Category are you applying? *

Which Housing Scheme are you applying for? *

Personal Details

Salutation *

First Name *

Last Name *

Email *

Date of Birth *

Gender *

Mobile *

Contact Details

Current Address Line 1 *

Address Line 2

Town / City *

Postcode *

Country *

Length of Stay at Current Address *

Phone Home

Phone Work

Next of Kin

First Name

Last Name

Relationship to you

Phone Work

Mobile

Doctor Information

Name of doctor

Practice and Address of Surgery

Residential Status

National Insurance Number *

Are you a citizen of either the UK or the European Union? *

Are you subject to immigration control? *

Is this a joint application with another person? yes,no *

Passport Number or Driver Licence *

Visa Number (if applicable)

No of Years on Visa

Visa Type

Country of Origin

Please give brief details of your reasons for wanting to move to a Pathways property *

Please indicate which applies to your current housing *

Your current accommodation *

Which of the following facilities do you share with other? *

Property Requirements

What type of accommodation do you wish to be considered for? *

Expenditure

Do you pay rent? *

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.

Electricity *

Gas *

Television subscription/Licence *

Water *

Telephone/Mobile/Broadband *

Council Tax *

Other *

Do you currently undertake any form of work? ( Including full-time, part-time or voluntary work) *

Have you ever filed for bankruptcy? *

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.

Housing Benefit *

Income Support *

Support People *

State Pension *

Private Pension *

Other Income/Savings *

Rehabilitation of offenders Act 1974

Have you ever had a notice for eviction issued or been evicted *

Please provide details if Yes

Have you ever been convicted for committing an anti-social behaviour offence, causing nuisance, or been found in breach of your housing agreement? *

Please provide details if Yes

Do you have convictions for a criminal offence other than a spent conviction under the Rehabilitation of Offenders Act 1974? *

Please provide details if Yes

Additional Notes

Please add below any further information that you feel may be relevant or assist us in dealing with your accommodation application *

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.

Gender *

Disability (physical and mental health) *

Religion or belief *

Ethnicity Monitoring

Ethnic background *

Personal Details
Contact Details
Next of Kin

By submitting your application, you are agreeing to the following terms:

1. I declare that the statements made by me in this accommodation application are true to the best of my knowledge and I agree to advise Pathways of any changes in respect to the information provided in this application as soon as they occur.

I understand that if I were found to have falsified information and therefore obtained housing by deception I may be prosecuted and may lose my home.

I agree that if I am offered accommodation, I shall occupy it as a beneficiary of the Charity and not as a tenant.

Any monthly or weekly sum I pay will be regarded as a maintenance contribution and not rent.

2. I agree with the processing of my data by Pathways Housing

Processing of your data is necessary in order to progress your request. The supplied data relating to you shall be kept for no longer than is necessary for the purposes for which it is being processed.

3. I agree to all data I submit being stored online in compliance with Arthur Online's GDPR and Privacy policies.