Contour Application for Housing.qxd:Layout 1 - Contour Homes

Who wants a Contour home
Joint Applicants must complete pages 8 and 9
If you would prefer us not to contact you at home, please give an address where we can write to you:
Address
Postcode
Have you or a member of your household applied to Contour Homes, Peak Valley
Rivers (Hillock) HA, AvenQuest Homes, Portico or Collingwood HA before? Yes No
If so what name did you apply in (if different)?
and from what address?
Postcode
Have you or a member of your household been a tenant of Contour Homes, Peak Valley
Rivers (Hillock) HA, AvenQuest Homes, Portico or Collingwood HA before? Yes No
If so, what name was the tenancy in (if different)?
What was the address?
Postcode
Do you have a social worker, probation officer or receive support from anyone else? Yes No
If yes, give details
Are you, or any of the people living with you pregnant? Yes No
If so, when is the baby due?
Please send us your Certificate of Confinement
Equal Opportunity
We have a policy of equal opportunity for all, irrespective of sex, colour, race or religious belief. To allow us to check
that all applicants are treated fairly, please indicate what best describes your ethnic origin. Please tick one below
from a, b, c, d, e or f.
You
Joint
Applicant
a) White British Irish Other
You
Joint
Applicant
You
Joint
Applicant
You
Joint
Applicant
b) Mixed White & Black White & White & Asian Other
Caribbean
Black African
c) Asian or Indian Pakistani Bangladeshi Other
Asian British
d) Black or Black Caribbean African Other
British
e) Chinese or other Chinese Other
ethnic group
f) I do not want to
answer this question
2