• Accommodation for Older People Application Form (William Jones's Almshouse, Monmouth, NP25 3AE)

    Bristol Charities Housing Criteria

  • William Jones’s Almshouse Charity

    Registered charity No 230514

  • Bristol Charities aims to assist the people in the greatest need living in Wales, and has therefore set criteria describing which applicants have the most priority.

     In order to qualify for one of William Jones's properties, you will need to show that:

    •  You have a housing need because of the physical condition of your present home
    • You have medical or social reasons for wanting to move such as poor health, disability, or isolation from friends and family
    • You do not own your own home or have capital in excess of £16,000
    • You live in the Monmouth area or have a strong local connection
    • You are capable of living independently in self-contained accommodation with any assistance only provided by family and Health and Social Care
    • You are currently in receipt of housing benefit, or are eligible for it
    • You are over 60 years of age

     If you feel you meet these criteria, please complete the application form as fully as possible.

  • PART 1: Personal Details - About you and your household

    • Partner's Details (if applicable) 

    • If applicable, please enter your partner's details:

    • Next of Kin Contact Details: 

  • PART 2: Referral Agency (where applicable):

  • PART 3: Income Details

    Please enter the total in £
    • Your Partner's Income Details (if applicable): 

  • PART 4: Accommodation Details

  • If you own property:

  • If you rent property:

  • PART 5 - Current Circumstances

  • PART 6 - Risks

  • PART 7: References

    Please provide details below for two references. One must be your current landlord. The other your GP, as they will be asked to comment on your medical suitability for accommodation

  • Reference 1

  • Reference 2

  • PART 8: Pets

  • PLEASE NOTE: Pets are strictly not allowed in William Jones's properties

  • PAGE 9: Declaration

    I certify that the details given in this form are correct to the best of my knowledge and that this application is submitted in good faith. I confirm that I am able to look after myself, with the assistance of family and Health & Social Care if necessary. I acknowledge that if I am appointed it will be as a licensee and I shall not be a tenant.
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  • If you have any queries regarding this application form, please contact the Service Manager for Housing Services on 0117 930 0301 or email:

    info@bristolcharities.org.uk

    You can also write to us at the following address:

    Bristol Charities

    17 St. Augustine’s Parade

    Bristol

    BS1 4UL

  • Equal Opportunities and Diversity Monitoring

  • We keep records of the ethnic origin of anyone who applies to us for accommodation for older people. This is to ensure that our service is provided on an equal basis without discrimination on the grounds of race, ethnicity, sexuality, gender or disability. Any information you choose to give us will be treated in confidence and used for monitoring purposes only. It will not affect your application.

    • Ethnicity: 
    • Sexuality: 
    • Marriage or Civil Partnership: 
    • Religion or Belief: 
    • Disability: 

  • BRISTOL CHARITIES (ORCHARD HOME) DATA PROTECTION CONSENT FORM

  • Bristol Charities is committed to meeting the requirements of the Data Protection Act 1998 and the General Data Protection Regulation EU 2016/679.

    We will only ask for personal information from you for the purpose of allocation of housing.

    The information requested will be used to assess whether you meet the criteria for housing within one of the charity’s properties.

    Any personal information you provide to us whilst making an application for housing will be maintained in private files on our internal systems for the duration of your stay in our property and for a period of seven (7) years after that. If your application for housing is unsuccessful your information will be destroyed.

    You can withdraw your consent at any time by emailing: info@bristolcharities.org.uk or by phone on the following number: 0117 930 0301.

  • Information Sharing with a third party

  • We will need to contact your G.P to provide information around your suitability for our housing and also your previous landlord for a reference.

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