Supported Housing Application Form

Supported Housing Application Form
CARE provides supported housing for individuals experiencing housing difficulties who require additional support to maintain independent living. Our supported housing offers a safe and stable environment where residents can access practical help, advice, and tailored support to develop the skills needed to move towards independent living. We work with individuals who may have experienced homelessness, unstable housing, financial hardship, or other challenges that make it difficult to maintain a tenancy alone. Our housing is designed to provide structure, guidance, and a stepping stone towards a more permanent housing solution.

Supported Housing is available for up to 2 years, with a focus on improving financial stability, health and well-being, tenancy skills, and overall independence. This application form helps us assess your housing and support needs to determine whether CARE's supported housing is suitable for you.

Eligibility Criteria

1. Homeless or under threat of homelessness

2. Aged 18 or over. Single applicants under 35 with no dependents will be considered on a case-by-case basis due to Housing Benefit allowances.

3. Single applicants over 35 may be eligible for a one-bedroom property.

4. In need of support to sustain independent living.

5. Receiving state benefits or on a low income.

6. Have a local connection to the area (e.g., lived here for at least 6 months in the last year or 2 out of the last 5 years, or other strong local ties

7. Able to engage with support services, as CARE's supported housing is limited to a maximum of 2 years.

8. You MUST have support needs during this time.

You will receive help to develop the skills needed for independent living. If you successfully complete the support programme, you may be eligible to apply for Band One with Home Choice Lincs to secure longer-term housing.

We require evidence of your circumstances to process your application.
Title of First Applicant

Other
Preferred Pronoun
First Name
Surname
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
National Insurance No
Address
Postcode
On what date did you move to this address

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Tel
Work Tel
Mobile Tel
Format: (00000) 000-000.
Email Address
example@example.com
If you have previously been known by another name please state it here
What language do you prefer to speak read and write in
What is your nationality
Do you have a Partner/ or other adult that will be housed with you?
Relationship to Joint Applicant
Title

Other
Preferred Pronoun
Name

First NameSurname
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
National Insurance No
Relationship to Joint Applicant
Address
Postcode
On what date did you move to this address

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Tel
Work Tel
Mobile Tel
Format: (00000) 000-000.
Email Address
example@example.com
If you have previously been known by another name please state it here
What language do you prefer to speak read and write in
What is your nationality
Why do you need supported housing
Have you ever been homeless?
Did a person or agency suggest that you come to us if they did who was it
Will any pets be re-housed with you?
Please tell us how many and what kind

Please tell us if you (or your partner/children) receive any benefits

Rows	Who Receives Benefit	Type of Benefit	Amount	Weekly/ Monthly
1
2
3
4
5

If you or your partner are employed, please supply the following details:

Rows	Name	Occupation	Name and Address of Employer	Length of Employment	Permanent or Temporary	Hours worked per week	Hourly Rate
1
2

We need to know who will be living with you permanently in your new home. Please seek consent with the members of your household before sharing this information with us

Rows	First Name	Surname	Sex M/F	Date of Birth	Relationship to you	Recieve Child Benefit? Y/N
1
2
3
4
5
6

If you have indicated that any of the people named in this section do not currently live with you at present, please give details below.

Rows	First Name	Surname	Sex M/F	Date of Birth	Relationship to you	Recieve Child Benefit? Y/N
1
2
3
4
5
6

If anyone named in section 1 or 2 is an expectant mother, please give details below:
Name of Expectant Mother
Date Baby is due

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Please provide details of where you have lived in the last five years (or last three properties: (First Applicant)

Rows	Address	Date From	Date To	Weekly Rent	Reason for leaving	Name and Address of landlord if rented
1
2
3
4
5
6

Please provide details of where you have lived in the last five years (or last three properties: (Joint Applicant if different)

Rows	Address	Date From	Date To	Weekly Rent	Reason for leaving	Name and Address of landlord if rented
1
2
3
4
5
6

Has any legal action been taken against you, your partner or any person who intends to live with you for anti-social behavior such as harassment or nuisance or have you previously been evicted for any reason?
If yes please give details including property address landlord details and reasons
If yes, please give details, including property address, landlord details and reasons:
If Yes, please give details
Emergency Contact

This section is for emergency contact purposes only. Your next of kin will not be contacted for any other reason unless you provide additional consent.
Name of Emergency Contact
Relationship of Emergency Contact
Contact Number of Emergency Contact
Address of Emergency Contact
Name of Emergency Contact
Relationship of Emergency Contact
Contact Number of Emergency Contact
Address of Emergency Contact

Please indicate which one applies to you:

Rows	Applicant	Joint Application
Council tenant
Housing Association tenant
Private tenant
In tied accommodation
Staying with parents/relatives/friends
Lodging
Owner occupier
In Armed Forces accommodation
Young person leaving Local Authority care
In prison
In hospital
In temporary accommodation

Please give us details of any Social Worker, Carer or other professional person who supports you.

Rows	Name	Section and Address	Telephone Number
Applicant
Joint Applicant

Please give us details of the person whom we can obtain a character reference from

Rows	Applicant	Joint Applicant
Character Reference Name
Professional/ Occupation
Address
Contact Number

Have you been given written notice? (Applicant)
If yes when do you have to leave
Why have you been asked to leave?
Has you been given written notice? (Joint Applicant)
If yes when do you have to leave
Why have you been asked to leave?

Rows	Applicant	Joint Applicant
Support with income/money
Support with finding training, education, work like activities (e.g. work experience / Voluntary work
Support with relationships with family and friends
Support/ advice with physical health
Support regarding alcohol or drug misuse
Support to reduce the risk to others
Advice regarding assistive technology/ aids and adaptions
Support regarding self-harm
Support with transport / Travel
Support to obtain paid work
Support / advice with mental health
Support to participate in social/ leisure activities
Support to reduce the risks from others
Support regarding offending behaviour
Support with setting up and maintaining permanent accommodation
Support to have more involvement in the community
Support/ advice on parenting skills and childcare

Supported Housing Application Form

Your Choice of Accomodation

Your Support Needs

DECLARATION FOR CARE SUPPORTED HOUSING