::: EAST CLEVELAND YOUTH HOUSING TRUST :::



	Introduction Who can take part?

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	Accommodation How to Apply

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	Rank Foundation

	Contact us Staff Useful links

Application for Accommodation

Date of application
Full Name
Date of Birth
Age
Address
Telephone
How long have you lived at this address?

Do you wish to share this tenancy with a partner?
Yes	No
If Yes please give partners details
Full Name
Age
Address
Telephone

Is this accommodation:
Parents' home	Housing association
Private rented	Council
Bed & Breakfast	Friend's home

Details of any other addresses you have lived at during the last 2 years:
Address	Landlord Dates	Why did you leave?
Address	Landlord Dates	Why did you leave?
Address	Landlord Dates	Why did you leave?
Address	Landlord Dates	Why did you leave?

Why do you need accommodation?
Would you be able to provide two refrences?
Yes	No
Areas we can offer assistance, if any apply to you please tick accordingly
Budgeting You're finances	Electricity suppliers
Council Tax	Gas Suppliers
Other
Other Please give details
Do you receive any support from other agencies e.g. Probation, Social Services, etc.?
If yes please give details
Are you - Please tick accordingly and give details
In Employment
Position held
Company Name & Address
Length Of Employment
In Training
Course details
In Education
College / Course details
Unemployed
If so for how long
Receiving Benefits
What kind
How did you hear about the property vacancy?
Other please give details
Any Other Comments/Suggestions

Equal Opportunities Monitoring Form East Cleveland Youth Housing Trust aims to make sure that all applicants are treated equally regardless of their origin, gender or disability. In order to monitor this policy we would be grateful if you could complete the details below. All information will be treated in the strictest confidence.
I am

Any disabilities or special needs	Yes No
If yes please explain

By pressing submit, I understand that this application form does not constitute an offer of accommodation. To the best of my knowledge this information is true and accurate.