Aldwyck Application For Housing Page 4
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20Part 4: special housing needs
Do you or does any member of your household have a
disability which has a serious effect on your or their ability to
Yes
No
Not sure
carry out normal day-to-day activities? This includes long-term
conditions like cancer, multiple sclerosis or HIV.
If yes, please tell us who, whether they are registered as disabled and which of the following
types of disability or illness they have.
Deaf or hard of hearing
Mental or emotional problems
Wheelchair user
Learning problems
Problems getting around
Any other disability
(please specify)
Long-term illness
Blind or partially sighted
Name
Type of disability or illness
You
Second person applying
Do you have a carer, family member or friend who helps you with housing problems?
Yes
No
Yes
No
If yes, and you are willing to let us contact them about your housing application,
please give their details.
Title
First name
Last name
Relationship to you
Address with postcode
Phone
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business