Application For Housing Assistance Form Page 4
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198a. Is your mailing/contact
Yes
No
Go to 8b.
address the same as your
give details
residential address?
Unit/House
number
Street/Avenue
Town/Suburb
Postcode
Contact a third party
8b. Who should we contact about your
Contact me directly
application?
(for example, a support worker,
advocate, friend or relative)
You will need to complete the General
Consent to Exchange Information &
Authority to Act on Client’s Behalf form
which can be downloaded from
9.
In what country were you born?
10. Are you of Aboriginal or Torres
Yes
No
Go to 11.
Strait Islander descent?
give details
Note: Aboriginality will need to be
Torres Strait
Aboriginal
Aboriginal
confirmed if you wish to access specific
Islander
and Torres
Aboriginal services.
Strait Islander
See item 3 on the Evidence Requirements
Information Sheet for details.
11. What is the main language you
Other
English
speak at home?
give details
12. What is your current citizenship?
Other
Go to 13.
Australian citizen
(Australian born or
Attach proof if you are an Australian citizen.
obtained citizenship)
See item 4 on the Evidence Requirements
Go to 14.
Information Sheet for more information.
13. What is your current residency
Permanent resident
status/visa category?
Sponsored migrant
Attach proof. See item 5 on the
Evidence Requirements Information
Sheet for details.
New Zealand Special Category Visa
Refugee/humanitarian
Asylum seeker
Visa subclass number
(if not relevant, write ‘not applicable’)
Date of arrival in Australia
DD/MM/YYYY
14. Do you or anyone on this
Yes
No
Go to 15.
application currently live in a
name of person who
social housing property?
currently lives in a social
Note: Social housing properties include
housing property
public housing, Aboriginal
housing and community
Name
Family Name
First Name
housing.
14a. If it is a community housing or
Aboriginal housing property, what is
the name of the provider that manages
this property?
DH3001 04/15
Page 2 of 16
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