Apply for a home — Gower Living

About you

Title

First name *

Last name *

Date of birth *

Gender

National Insurance no.

Phone *

Email *

Next of kin / emergency contact

Name

Relationship to you

Phone

Your current housing

Where are you living now? *

Who provides it? (council, hostel, hotel…)

Date you moved in

This helps us see how long you've been in temporary accommodation.

Current address

Why are you looking for a home? *

Preferred area or type of home

Sharing & household

Many of our homes are shared houses. This helps us place you well.

Would you be happy to share a house with one other person? *

Yes Maybe No, I need my own place

Is there someone you'd like to share with, so we can house the two of you together?

No Yes

Their name

Your relationship to them

Their phone (if known)

Money

This helps us check the home is affordable and set up rent payments smoothly.

Which benefits do you receive? *

UC housing element (£ / month)

Day of month UC is paid

How long on Universal Credit?

PIP (£ / month)

How long on PIP?

Approx. total monthly income (£)

Employment status

Are you happy for the rent to be paid straight to the landlord from your Universal Credit (Managed Payment)? *

Yes No Not on UC

A Managed Payment means your housing costs go directly to us, so you don't have to worry about the rent.

Do you have any rent arrears from a previous home? *

No Yes

Brief details (amount, and whether it's being repaid)

Any deductions or debts coming out of your benefits?

No Yes

Brief details

Your housing history

Previous landlord — name

Previous landlord — contact

May we contact them for a reference?

Yes No No previous landlord

Reason for leaving your last home

Have you ever been evicted or had a possession order? *

No Yes

Brief details

Health & wellbeing

This helps us offer a suitable home and the right support. Share what you're comfortable with.

General health / any medical conditions

Can you manage stairs?

Yes With difficulty No

Any physical disability or mobility needs? (e.g. ground‑floor only, wet room, wheelchair access)

Any communicable diseases (e.g. Hepatitis B/C, HIV, TB)?

No Yes Prefer not to say

Details (only what you're comfortable sharing)

Mental health — current support needs

Mental health history

Support & background

We house people from many situations, including people leaving custody. Please be honest — it won't automatically rule you out; it helps us place you in the right home with the right support.

Do you have a support worker?

Are you a care leaver?

Support worker name, organisation & contact

Are you fleeing domestic abuse?

No Yes Prefer not to say

Do you have any unspent criminal convictions? *

No Yes

How many separate offences?

On licence until (if applicable)

Offence(s), dates and sentence

Any licence conditions, restrictions or exclusion zones?

Are you on probation or supervised? *

No Yes

Probation officer name & contact, and end date

Drug or alcohol support *

Brief details (substances, last use, who supports you)

Declaration

Your details are stored privately for the housing team.

Apply for a home.