Community Housing Application Form

Community Housing Application Form

Information on this form is confidential
IMPORTANT INFORMATION
- To be eligible as a Community Housing tenant, applicants must provide evidence that they are listed on the NSW Housing Register.
- All completed Application Forms will be thoroughly assessed and applicants who appear to be eligible will be placed on a Waiting List to be considered for future vacancies.
- Being placed on a Waiting List does not mean that you will eventually be offered housing with Anglicare North Coast. We manage a limited number of properties and usually have several people to choose from for each vacancy that occurs.
- To remain on our waiting list, applicants must respond to our annual request for an update of their circumstances, even if nothing has changed. Applicants will also need to remain listed on the NSW Housing register.
- When a vacancy occurs, interviews are conducted to select the applicant who best meets our selection guidelines.
- A number of factors are taken into account when new tenants are being selected, including who has the greatest housing need, length of time on waiting list and which applicant best suits the property that is available, in terms of size and locational preference.
- If you are requested to attend an interview, you will be required to bring with you proof of income and identification.
- It is important that you complete the Consent Form (page 7 of this form) so that Anglicare North Coast can conduct any necessary background checks.

BEFORE YOU CONTINUE
Are you registered with NSW Housing? *

Yes No
Please attach a statement from NSW Housing to confirm your active listing on theNSW Housing Register, and your Application Reference Number. For more information contact North Coast Community Housing in Grafton on 6642 9100.

Cancel of

We cannot accept applications for people who are not listed on the NSW Housing Register. You can contact North Coast Community Housing in Grafton on 02 6642 9100. You can also apply online, click the button below to start the process.

Apply Online to NSW Housing

Alternatively, feel free to reach out to us at any time:
- Phone: (02) 6645 1244
- Email: admingrafton@anglicarenc.org.au

SECTION 1

PERSONAL DETAILS
Applicant's Name *

First Name Middle Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Current Address *

Street Address

Street Address Line 2

Suburb State

Postcode
Date of Birth *

Day Month Year
Date
Gender

SECTION 2

DETAILS OF ALL OTHER PERSONS TO BE HOUSED
Are you a single applicant? I.e. no other persons to be housed *

Yes No

Please complete the following information concerning all other persons to be housed under this application (DO NOT include the applicant) *

	SURNAME	GIVEN NAMES	M/F	DATE OF BIRTH	RELATIONSHIP TO APPLICANT
#1
#2
#3
#4
#5
#6

Are any of the people to be housed pregnant? *

Yes No
Name of pregnant household member:
Expected birth date

SECTION 3

LOCATIONAL PREFERENCE
Please indicate below which town(s) you would like to be housed in. You may select more than one. *

Yamba Maclean Murwillumbah
Please note that Anglicare North Coast has general Community Housing properties in the listed locations above.

If you prefer housing within other locations, please register for housing assistance at your nearest Housing NSW office.

SECTION 4

HOUSEHOLD NEEDS
Do any of the persons to be housed have any kind of disability or medical condition that requires a particular location or a special kind of house? *

Yes No
Please give brief details of their disability / medical condition and their special housing requirements.

SECTION 5

ELIGIBILITY
5a) General Eligibility
Are you either a Permanent Resident or Citizen of Australia? *

Yes No
Do you identify as Aboriginal or Torres Strait Islander? *

Aboriginal Torres Strait Islander No Prefer not to say

SECTION 5 - CONTINUED

ELIGIBILITY
5b) Details of Assets
Do any of the people to be housed own or part own any residential property? (e.g. house, unit, mobile home etc.) *

Yes No
What type of property is owned and where is it located?
Do any of the people to be housed own or part own any type of business? *

Yes No
Give brief details, including value of the business
(NB - Any income derived from this business must be included in Income Details in the following section of this form)

SECTION 5 - CONTINUED

ELIGIBILITY
5c) Income Details

Please note that income details must be provided for all persons who are to be housed. You must include all income, including Centrelink payments, Dept of Veterans Affairs payments, wages and salaries, Foreign Pensions, investment income, Child Support / Maintenance Payments. *

	Name	Income Source (e.g. Centrelink, Dept. Veterans Affairs)	Type of Payment (e.g. Diability Pension, Newstart)	Gross Amount per fortnight
#1
#2
#3
#4
#5

SECTION 7

PREVIOUS HOUSING

Please provide details of properties you have lived in during the past 3 years. *

	Address of Property	Period you lived at this address	Name of Landlord	Telephone No. of Landlord
#1
#2
#3
#4
#5

SECTION 8

CONSENT INFORMATION

Anglicare North Coast may need to check some of the information provided in this application form and/or your interview. Please indicate if you give permission for Anglicare North Coast to contact the following Agencies or people regarding your application for tenancy *

	Contact Name	Telephone	Consent (Tick for Yes)
NSW Department of Housing
Other community housing associations:
Agency which referred you to Anglicare:
Agencies providing support to you now:
Agencies providing support to you during the tenancy:
Your Case Manager:
Other:

Continued... *

	Details
Previous landlords or agents: Address of property rented:
Previous landlords or agents: Address of property rented:
Previous landlords or agents: Address of property rented:

SECTION 9

ADDITIONAL INFORMATION
Please indicate below any additional information that you think may be relevant toyour application.

SECTION 10

VERIFICATION
Signature *

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Community Housing Application Form

IMPORTANT INFORMATION

BEFORE YOU CONTINUE

SECTION 1

SECTION 2

SECTION 3

SECTION 4

SECTION 5

5a) General Eligibility

SECTION 5 - CONTINUED

5b) Details of Assets

SECTION 5 - CONTINUED

5c) Income Details

SECTION 6

SECTION 7

SECTION 8

SECTION 9

SECTION 10