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Tenant Application
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Name
*
First
Last
Email
*
Mobile Number
*
Date of Birth
National Insurance Number
*
of storing in
Gender
*
— Select Choice —
Male
Female
Trans Man
Trans Woman
Your Current Address
*
Support Needed
*
— Select Choice —
Mental Health
Drugs Use
Alcohol
Physical Health
Autism
Other
Are you Claiming Benefits?
*
Yes
No
Which Area or Post Codes are you willing to live in Birmingham?
*
Type of HMO
2 Bedroom
3 Bedroom
4 Bedroom
5 Bedroom
6 Bedroom
Any
Subject to availability, Please tick which HMO you are willing to live in. Please note that we do not have 1 bedroom flats, our rooms are all within shared accommodation and where a 2 bedroom and 3 are limited, 4+ maybe available.
Please tell us the current housing provider you are with:
*
Are you applying as a single person or do you have friends/partner/relatives who require rooms?
*
Tick All The Benefits You Are Currently Claiming:
*
Universal Credit
Personal Independent Payments
Limited Capability For Work
Carers Allowance
Can Jahn Housing Contact you when a room is available?
*
Yes
No
I consent to Jahn Housing storing my data in line with GDPR and the Privacy Policy."
*
I consent
Submit
