Sandwell Self Contained Block Tenant Request Form
We have an upcoming block of flats that will become available by December 2026. If interested in this specific property please follow the form. MINIMUM 2 BENEFITS ARE REQUIRED
Important:
We do not accommodate children or anyone under the age of 18.
What type of benefits do you receive? (Minimum 2)
*
Universal Credit (UC)
PIP – Personal Independence Payment
LCWRA – Limited Capability for Work and Work-Related Activity
ESA – Employment and Support Allowance
Carer's Allowance – For people caring for someone with qualifying needs
Other (please specify)
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone number:
*
Are you over the age of 18? (We cannot house under 18s)
*
Yes
No
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Ethnicity
*
Please Select
Asian
Black or African American
Hispanic or Latino
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to say
Do you have any mental health needs we should be aware of?
*
How urgent is your need for accommodation?
*
Few weeks
1-2 months
Not urgent
Do you have a criminal history?
*
Yes
No
Reason for conviction (Put N/A if not applicable)
*
Reason for seeking accommodation
*
Drug or Alcohol
*
Yes
No
If ticked Yes, What is your intake like?
*
History of Arson
*
Yes
No
Are you aware the location is in Sandwell?
*
Yes
No
Do you require parking?
*
Yes
No
Utility Bills & Financial Responsibility
Each flat is fully self-contained. All tenants are responsible for setting up and paying their own utility bills, including electricity, water and any other applicable household bills.
Do you understand and confirm that you are financially capable of paying your own utility bills throughout your tenancy?
*
Yes, I understand and confirm I can pay my own utility bills.
No, I am unable to take responsibility for my own utility bills.
Property Preference
Would you prefer the property furnished or unfurnished?
*
Furnished
Unfurnished
I don't mind
Submit Request
Should be Empty: