1

    Applicant
    Details

    2

    Equality &
    Diversity

    3

    Referrer
    Details

    4

    ID &
    Income

    5

    Housing &
    Tenancy

    6

    Support
    Needs

    7

    Harm
    Screening

    8

    Risk of
    Reoffending
    & Harm

    9

    Other
    Agencies

    10

    Finish
















    Please note proof of ID will need to be provided at the Panel Assessment







    Housing history

    Please provide a complete history of your / the applicant’s housing history covering the last 5 years. Please include temporary housing, hospital admissions, prison sentences, homelessness etc. For ‘Type of accommodation’ please specify (private rental, B&B, staying with friends, living with family, hostel, hospital, prison, local authority, housing association etc.)






    Current Accommodation




    Support Needs

    This section is one of the most important as it helps us to understand how best we can support the applicant whilst residing with us and helps us to consider which of our properties would best support their rehabilitation.





    Please identify any relevant risk indicators below including details about the behaviour and any protective factors that mitigate the level of risk.

    Have you / the applicant ever been convicted of…







































































    Please give details of any other agencies involved in the management and support of the applicant

    Children’s Services / Adult Social Care

    Mental Health Worker / CPN / Psychiatrist

    Counsellor

    Drug / Alcohol Worker

    Operational Partner

    Voluntary / Charity Organisationr

    Other

    Other

    Other

    Applicant Consent:

    I give consent for the information contained herein to be shared with other agencies for the purpose of assessing and addressing my housing and support needs.

    I give consent for the referrer to obtain and provide further information, some of which may be special category information regarding any criminal or social/medical history from relevant agencies regarding my support needs.

    I understand that Reactive8 Housing may enquire and seek further information appropriate to my application for housing and give consent for the appropriate professionals, familiar with my history, housing and support needs to release information about what is deemed necessary and appropriate to my application upon request.
    I understand that I can withdraw my consent for Reactive8 Housing to access and/or share personal information related to me at any time upon making a written submission to this effect. I understand that withdrawing consent to access and/or share information will invalidate any Licence Agreement that I may have entered with Reactive8 Housing and that any offer or supply of accommodation will be withdrawn.

    Please double check the application before submission. Any errors in the application may delay the process taking longer than expected.

    Once happy, click submit below