Hillhomes | Trees Application Form

Your information:

Title: *

First name: *

Surname: *

Have you been known by any other name?:

Yes No

If you answered 'Yes', please state what it was?:

Date of birth:

Gender:

Female Male

National Insurance No.

Current Address:

Postcode:

Contact Details:

Home Telephone No.:

Mobile Telephone No.:

Email Address: *

Please tell us the following information

Do you have the right to resident in the United Kingdom?

Yes No

Are you seeking asylum in this country?

Yes No

If you are in the process of applying for the right to remain in the UK or seeking asylum, this
might affect your application. In which case, we will ask you for further information and proof
about this. This will also apply to anyone else who you have included on this application.

If anyone else wants to live with you i.e. spouse/civil partner/carer, please give the following information:

Title:

First name:

Surname:

Have you been known by any other name?:

Yes No

If you answered 'Yes', please state what it was?:

Date of birth:

Gender:

Female Male

National Insurance No.

Current Address:

Postcode:

Contact Details:

Home Telephone No.:

Mobile Telephone No.:

Email Address:

Please tell us the following information (to be completed by second person on this application)

Do you have the right to resident in the United Kingdom?

Yes No

Are you seeking asylum in this country?

Yes No

Have you or anyone who would like to live with you
previously made an application to us for Housing?

Yes No

If you answered 'Yes', what name is the application in?

Please tell us who your current landlord is or who you
live with.

Communication Needs

Please tell us if you need any help in communicating with us, either due to needing translating
services or due to a disability or other factor.

What type of accommodation do you live in now (if renting, please give brief details of your landlord)?

Do you own your home?

Yes No

How many bedrooms are there?

Do you share a bedroom?

Yes No

If you answered 'Yes', who do you
share with?

Do you share a bathroom or kitchen?

Yes No

If you are not currently living in Haringey, please state whether you have lived in the borough before and when, and/or if you have any close relatives currently living in the borough.

Please tell us why you want to be rehoused:

What type of property do you require?

Other information

Are you known to Haringey Social Services?

Yes No

Do you have a social worker?

Yes No

Are you registered with a GP in Haringey?

Yes No

Do you have anybody who could/would help you move in?

Yes No

Consent

In order to assess your application, we may need to seek further information, either from
yourself or anyone currently providing a service to you. However, we cannot discuss your
application for housing with anybody other than you. Before we discuss your application with
anybody else on your behalf, we must have your permission in writing. If you would like to grant
permission please sign below.

I/We hereby give permission for Hill Homes to discuss my/our application with the following
individuals or authorised officers from the following agencies/organisations

Individuals

Name

What you would like us to discuss with them?

Agency/Organisation e.g. Age UK, GP etc

What you would like us to discuss with them?

Additional Information

If you are offered accommodation with the Association, a full support/care assessment will be
carried out (you may have had these done already) but it would help us if you could tell us
anything that would enable us consider what support you may benefit from if you move into one
of our schemes.

Disability (please choose from the following that best describes the disability)

Financial management (please tell us if you feel you would benefit from finance/benefit advise and support)

Social inclusion (Please tell us if you would like some support with socialising, making/finding friends and keeping in touch with family

Health and wellbeing (please tell us about anything that concerns you about your health and you think we need to be immediately aware of)

Tenancy sustainment (Pleas tell us if you have any concerns about maintaining a tenancy if you move into one of our homes)

Application Monitoring Form

ETHNIC GROUP:

SEXUAL ORIENTATION:

GENDER:

Female Male

RELIGION/BELIEF:

AGE GROUP:

55-65 66-75 75 and over

I CONSIDER MYSELF
TO HAVE A DISABILITY:

Yes No

MEDICAL SUPPORT STATEMENT - REHOUSING APPLICATION

Your information:

Please tell us the following information

If anyone else wants to live with you i.e. spouse/civil partner/carer, please give the following information:

Please tell us the following information (to be completed by second person on this application)

Communication Needs

What type of accommodation do you live in now (if renting, please give brief details of your landlord)?

Please tell us why you want to be rehoused:

What type of property do you require?

Other information

Consent

Additional Information

Financial management (please tell us if you feel you would benefit from finance/benefit advise and support)

Social inclusion (Please tell us if you would like some support with socialising, making/finding friends and keeping in touch with family

Health and wellbeing (please tell us about anything that concerns you about your health and you think we need to be immediately aware of)

Tenancy sustainment (Pleas tell us if you have any concerns about maintaining a tenancy if you move into one of our homes)

Application Monitoring Form