Housing Application Form - Adactus Housing Group Ltd

PART FIVE - Accommodation Requireda) Please indicate in order of preference what type of property you require:(ie 1=1st Preference, 2=2nd Preference, 3=3rd Preference, etc)■ House ■ Supported ■ Sheltered Housing (55yrs+) ■ Sheltered with Extra Care■ Bungalow Accommodation ■ Sheltered Ground Floor (Mental health needs)■ Ground Floor Flat(16-25 years)■ Sheltered First Floor■ First Floor Flat■ Sheltered with Extra Care (55yrs+)b) How many bedrooms would you prefer? ...............................................................................................................If you require more bedrooms than might be considered reasonable in your circumstances, please explain yourreasons and if possible provide written evidence.c) Which areas would you like to live in?To help you choose the Association has provided a map with a list of all its accommodation. You can have asmany choices as you like but please only choose areas which you would consider:1st ............................................................................ 4th .................................................................................2nd ......................................................................... 5th .................................................................................3rd .......................................................................... 6th .................................................................................PART SIX - Reasons for Applying for AccommodationPlease tick why you are applying for accommodation:- Homeless or potentially homeless ■- Living in temporary or supported accommodation ■- Experiencing domestic violence or fear of violence ■- Suffering serious racial or other harassment ■- Overcrowded ■- Need a smaller home ■- Pregnant woman/children under the age of 12 living above first floor level ■- Living in poor conditions e.g dampness, lack of amenities ■- Need to move because of a relationship breakdown where children are involved ■- Medical condition made worse by current housing ■- Moving to be nearer to college/work ■- No specific housing need but would like to move ■Continued…