Apply for Housing

Full name

Date of Birth

Gender

Phone

Current address

Preferred Mode of Contact

Support Needs

Reason for seeking accomodation

Current support services(if any)

Type of Care/Support Needed

Mental Health Support

Physical Health Support

Daily Living Assistance

Social Support

Other

Health Information

Primary Health Condition

Secondary Health Condition(if any)

Medications

Doctor/Healthcare Provider

Healthcare Provider Contact Number

Accommodation Preferences

Preferred Move-in Date

Specific Accommodation Needs or Preferences

Additional Comments

I consent to Havencrest processing my personal data for the purpose of providing supported living accommodation.

I declare that the information provided is true and accurate to the best of my knowledge.

Disclaimer: The information provided in this form is used solely for the purpose of assessing and processing your application for supported living accommodation with Havencrest Limited. Submission of this form does not guarantee acceptance into our housing program. All applications are subject to review and approval based on our criteria and availability.

Confidentiality and Data Protection: At Havencrest Limited, we take your privacy and data protection seriously. The information you provide in this form will be treated with the utmost confidentiality and will only be used for the intended purpose of processing your housing application. We adhere to all applicable data protection laws and regulations to ensure that your personal data is securely stored and protected. Your information will not be shared with any third parties without your explicit consent. If you have any questions or concerns about how your data is handled, please feel free to contact us at info@havencresthousing.co.uk