Application Form

About Filling In This Form

This application form is made up of a number of pages of questions. You do not need to complete all of this form in one sitting. If you need to take a break and come back to the form at a later date, select the Save and Continue Later option at the bottom of the page you are on and follow the instructions.

Important: This is a legal document. You must answer all the questions that apply to you honestly and in full, then sign the data sharing consent at the end of the form. If you are applying jointly you must both sign.

If you give false, misleading or fail to give relevant information on this form, you will have committed a criminal offence and you may have your application cancelled, be prosecuted and/or have your property taken off you by a court.

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About You
Name*
Title First Name(s) Family Name
Previous Names
If you have ever been known by any other names, please enter them here.
Gender*
Date of Birth*
Hidden
Age*
National Insurance Number*
Current Address*
Line 1 Line 2 Town/City County Postcode
When did you move to this address?*
Mobile Phone Number*
Home Phone Number
Work Phone Number
Email Address*
Enter Email Confirm Email
Correspondence Address*
Same as Current Address

Line 1 Line 2 Town/City County Postcode
What is your current occupancy status?*
Please specify your current occupancy status*
Landlord's Name*
Landlord's Address*
Line 1 Line 2 Town/City County Postcode
Landlord's Phone Number
Landlord's Email Address

Previous Address History

Please give your previous address history for the last 5 years. Add as many addresses as you need to cover this period.

Address	Date From	Date To	Actions

There are no Addresses.

Nationality*
Immigration Status*
Please specify your Immigration Status*
Marital Status (optional)
Are you habitually resident in the UK, Ireland, Isle of Man or Channel Islands?*
- Yes
- No
Are you making a joint application?*
- Yes
- No

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About Your Partner
Name*
Title First Name(s) Family Name
Previous Names
If your partner has ever been known by any other names, please enter them here.
Gender*
Date of Birth*
Hidden
Age*
National Insurance Number*
Partner's Current Address*
Same as your Current Address

Line 1 Line 2 Town/City County Postcode
When did your partner move to this address?*
Mobile Phone Number*
Home Phone Number
Work Phone Number
Email Address*
Enter Email Confirm Email
Correspondence Address*
Same as your Current Address

Line 1 Line 2 Town/City County Postcode
What is your partner's current occupancy status?*
Please specify your partner's current occupancy status*
Landlord's Name*
Landlord's Address*
Line 1 Line 2 Town/City County Postcode
Landlord's Phone Number
Landlord's Email Address

Previous Address History

If different from your address history, please give your partner's previous address history for the last 5 years. Add as many addresses as you need to cover this period.

Address	Date From	Date To	Actions

There are no Addresses.

Nationality*
Immigration Status*
Marital Status (optional)

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About Your Household

Members of your Household

Please give details of all other household members currently living with you, or that will be living with you. Please also advise if they will be moving with you or not.

Name	Date of Birth	Age	Gender	Relationship to Primary Applicant	Moving in full time with Primary Applicant?	Actions

There are no Members.

Reason for Rehousing
If any of your household members are not currently living with you but are to be rehoused with you, please give their name, current address and briefly explain why they are not living with you and why they need to live with you.
Reason for not full-time
Are there any members of your current household who will not be moving with you? (please give details)
Do you have child access?*
- Yes
- No
Please give details of gender and ages, including arrangements or if a 50/50 shared care agreement between parents or a court order.*
Is anyone in your household pregnant?*
- Yes
- No
Who?*
When is the baby due?*
Are any members of your household studying away full time?*
- Yes
- No
Please give details.*
Are you currently fostering or considering fostering or adoption?*
- Yes
- No
Please give details.*
Do you or anyone in your household who is moving with you have any unspent or pending convictions?*
- Yes
- No
Please give details of who was convicted, what the conviction(s) is/are, sentence served, date of conviction(s) and circumstances of the offence(s)*
Specifically, are you or any member of your household subject to the notification requirements of the Sexual Offenders Act (2003)?*
- Yes
- No
Please give details of who was convicted, what the conviction(s) is/are, sentence served, date of conviction(s) and circumstances of the offence(s)*
Does anyone in your household have any debts owing to a previous landlord, current landlord(s) or mortgage provider(s)?*
- Yes
- No
Please give details of who owes the debt, the debt remaining, who the debt is owed to and the circumstances.*
Has anyone in your household been involved in antisocial behaviour, eviction, refused accommodation or had their home repossessed?*
- Yes
- No
Please give details of whom, the landlord/mortgage provider's name, address, telephone number, email address and the circumstances.*
Does anyone in your household have pets?*
- Yes
- No
Please give details.*

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Do you need help looking for housing?
Would you like an advocate to represent you?*
- Yes
- No
Their Name
Title First Names Family Name
Their Current Address
Line 1 Line 2 Town/City County Postcode
Phone Number
Email Address
Please tick all that apply
- Friends
- Relatives
- Support Workers
- Other
Is anyone in your household receiving official support such as from a social worker or probation officer?
- Yes
- No
Please confirm how often and who provides this support, including the contact details of the support/social worker/probation officer.

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Equal Opportunities Monitoring
Shropshire HomePoint aims to ensure its services are accessible to all and applicants are treated fairly. To help us do this, would you please complete the details below. This information is kept confidential.
Sexual Orientation
As the primary applicant how would you describe your sexual orientation?
Ethnic Origin
As the primary applicant, how would you describe your ethnic origin?
Faith
As the primary applicant, how would you describe your faith?

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Data Sharing Consent

I declare the information given on this form is true to the best of my knowledge and any information regarding other people has been given with their consent. I understand that any false or misleading information given, may lead to me being ineligible for housing, prosecution and eviction from the property.

I also understand that in compliance with the Data Protection Act 2018 and where legitimately required, Shropshire Rural Housing may now or in the future ask for and share information with other appropriate individuals and organisations. Examples of where this might be necessary include, unspent criminal convictions, anti-social behaviour, health information, credit checks, landlord references, nominations and referrals to provide support or other housing solutions.

By signing this declaration, I give permission relating to me and my household to store and email information securely and electronically. I also agree, where applicable, to be contacted in writing, by telephone, text message and email.
Primary Applicant Name*
Consent*
I agree to the above statements
Joint Applicant Name*
Consent*
I agree to the above statements

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Step 1 of 13

About Filling In This Form

About You

About Your Partner

Local Connection

About Your Household

About Where You Live Now

Employment and Financial Details

Your Employment Details

Your Partner's Employment Details

Financial Details

Health and Support Needs

Housing Support Needs

Overnight Care

Reason for Moving

Do you need help looking for housing?

Checklist

Equal Opportunities Monitoring

Data Sharing Consent