Please complete the below form online or download, print, complete and post the application to us
>>
Please complete the form and be frank with us. We re asking the questions set out below so we can make sure we have the right information to help us decide whether Mayes Gardens will suit you and whether we can give you the help and support you need. If you want any help filling out the application form or have any questions please contact us on 0161 273 6611.
1. Name
2. Address
3. Telephone Number
4. Email Address
5. Date of Birth
6. Is this a joint application? Yes
No
Please give their details including name and date of birth:
7. Please give details of your addresses in the last 7 years
1. Address: From: To: Landlord: Reason for Leaving 2. Address: From: To: Landlord: Reason for Leaving 3. Address: From: To: Landlord: Reason for Leaving
8. Mayes Gardens is provided for the benefit of people who have a local connection to Manchester. In some circumstances we may also consider connections to Greater Manchester areas.
Please tell us about your connection with Manchester or the surrounding area.
9. Why do you want to move?
Overcrowding
The property is too big for me
Health/medical
My landlord needs the property back
There are repairs problems
I have no permanent home
Relationship breakdown
Domestic Violence
I have been legally evicted
My home is being repossessed
I have got financial difficulties
I am being discharged form an institution
Racial or other harrassment
To be near family
I have no fixed address
Need to independance
Please give details about why you want to move
10. Are you in need of sheltered housing? Yes
No
Please give details
11. Are you experiencing harassment or threats of violence?
Yes
No
If yes, please give details
12. When did you move into your current address?
13. What type of property are you living in now?
House
Flat
Maisonette
Bungalow
Bedsit
14. In your current accommodation are you?
Renting form the council
Renting from a housing
association
Owning/Buying
Temporary accommodation
Bed and Breakfast
Renting - private landlord
Renting with job
With family/friends
Mobile Home
Hospital
15. If renting please provide the name and address of your current landlord
16. Please tell us about any long standing or permanent health problems or disablility you or the joint applicant have.
17. Do you receive support or assistance in any of the following ways?
Home Care
Yes
Regular visits from GP
Yes
Visits from a nurse
Yes
Day care at a day centre
Yes
Meals Delivered
Yes
Visit from a volunteer
Yes
Regular help with domestic tasks from relatives
or friends
Yes
Regular help with personal tasks from relatives
or friends
Yes
If you have ticked yes to any of the above please provide details here
18. Do you receive support from any other agency eg social worker, probation officer, mental health team etc.? If so tel us who they are and where they can be contacted.
19. Please tell us about their contact with you such as what they help you with and how often you see them.
20. Is there anything else that you think we should know about which is relevant to your application?
21. Do you have permission to reside permanently in the UK?
Yes
No
22. Do you have any pets?
Yes
No
If yes, please give details
23. Please provide the name and address of your GP
in word
in pdf
