*Fair access and diversity

It is against the law to discriminate against anyone because of their race, colour, ethnic or national origin, physical disability, gender or marital status. Rockdale Housing Association keeps records so that it can ensure compliance with the legislation. If you choose not to answer this question, your application will not be affected in any way.

Accommodation preferences

Rockdale rented apartments

There are 123 rented apartments at Rockdale situated in Rockdale Road, Sevenoaks. 80 of these are studio apartments and 43 have a separate bedroom and living room. All rented apartments are self-contained with individual kitchens and bathrooms. Most blocks are arranged on two floors, some with a lift and the Beatrice Wilson block of apartments is arranged on three floors, all having lift access.

Rockdale leasehold apartments

There are currently 28 leasehold apartments in Akehurst Lane, Sevenoaks in two blocks; Webbs Meadow and Constant Meadow. There are 26 two bedroom and 2 one bedroom apartments and they are all self-contained. They are all accessible by stairs or stairlift with the exception of one apartment. There are a further 29 leasehold apartments on the main Rockdale Road site of which 18 have 2 bedrooms and 11 will have one bedroom. They will all be accessible by lift and stairs.

I/we would like to apply for:
A rented apartment in RockdaleA leasehold apartment in Akehurst Lane or Rockdale RoadBoth types

Someone to act on your behalf

You can choose someone else to act on your behalf if you wish. If you name someone here, we will send all correspondence to them and phone them if we need to:

Pets

Do you have any animals you would like to bring with you?
YesNo
If yes, what animal would you like to bring with you? What size and age is your animal?

Your current tenure

Which of the following best describes your current tenure?
Owner/occupierPrivate tenantRenting from a housing association or local authorityLiving with friends or familyOther, please give details
Other

Do you need to leave for any reason?
YesNo
*If you need to leave, is it because:
You are statutorily homeless or will be imminentlyYou are living with friends or relatives and you have no right to stay thereThere has been a relationship breakdown and you have no rights to stay in your current homeOther
If you need to leave, please give the reason below

Your current accommodation

Which best describes where you live?
HouseFlat/apartmentBungalowOther, please give details
Other

How many of the following does it have?

Do you share any rooms or facilities, for example a kitchen or bathroom, with any other households?
YesNo
Please give details

Which of the following best describes your current accommodation?
It has a full range of amenities including a kitchen, bathroom and central heatingIt is in a poor stage of repair and/or lacks some basic amenitiesIt is unfit to live in
Does your accommodation have any features which make it difficult for you to live there?
YesNo
If yes, what are these?
Outside stairsInside stairsNo cloakroom downstairsGarden difficult to manageOther, for example it is affected by noise, pollution or you are experiencing harrassment
Please give details of any features which make your accommodation difficult for you to live there.

Adaptations

Has your home been adapted in any way to help you, for example grab rails, bath seats, stair lifts?
YesNo
If yes, what adaptations have been made?

Your medical health

In this section, please tick one box which most closely matches your current situation.

Your social and welfare needs

How far are you from these facilities (in miles)?

Shops

Doctor

Social facilities, for example clubs or other meeting places

Which best describes your method of transport?
I/We own and drive a carPublic transport is available and can be relied on as a means of transportPublic transport is available but the service to my/our home is unreliable or unsatisfactoryI/We rely on friends and/or relatives for transportI/We find it very difficult to get out as there are no methods of transport to use

Do you need any help with the following? If yes, please give details of any arrangements you currently have in place in the boxes provided.

Shopping
YesNo

Cooking
YesNo

Laundry
YesNo

Medical needs – for example, taking medication and changing dressings.
YesNo

Managing your finances – for example, paying bills, checking income.
YesNo

Your care – do you have a care package in place arranged.
YesNo

Personal care, for example bathing, getting in or out of bed, meal supervision
YesNo

Your support – do you have support from family, friends or neighbours who you see regularly and that you can rely on to help you?
YesNo

Cleaning
YesNo

Your personal finances (income)

State retirement pension
YesNo
If yes, how much do you receive (£)?

Housing Benefit
YesNo
If yes, how much do you receive (£)?

Attendance Allowance
YesNo
If yes, how much do you receive (£)?

Other pensions, for example from past employment
YesNo
If yes, how much do you receive (£)?

Do you receive income from any other sources?
YesNo
If yes, please give the source and amount of other income (£)?

Your personal finances (assets)

If you own your home, please give an estimate of its current value. If there is a mortgage outstanding, please give the amount.

Do you have any other assets, for example bank accounts, investments or other properties? Please give an estimation of the total amount of your assets excluding the value of your home.
YesNo
If yes, please give details

Have you given away or transferred any assets with a value of over £10,000 to another person or into a trust in the last 5 years?
YesNo
If yes, please give details

Other information

Is there any other information you wish to give us which you think is relevant to your application, for example, the reasons you would like to move here or any family or other links you have with the area?

Are you related to any member of the Association’s Board of Trustees or staff?
YesNo
If yes, please give their name and your relationship with them.

Declaration and signatures

General Data Protection Regulation 2018

The information you provide will be held securely and in accordance with the
General Data Protection Regulation 2018. Our Privacy Notice can be found
on our website at www.rockdale.org.uk

By completing this application form, I consent to information being shared
with third parties if we need to make further enquiries in support of your
application. This may include current or previous landlords, medical
practitioners or care managers. Rockdale will not pass on information to third
parties for any other reason.

Declaration form

Does one or more of the criteria listed below apply, or has it applied during the last 6 years to any applicant?

Do you have a history of anti-social behaviour?
YesNo
Do you have a history of drug related offences?
YesNo
Do you have a record of offences against children?
YesNo
Do you have a record of other criminal offences that have a relation to community matters?
YesNo
Do you have a conviction for a criminal offence, other than a spent conviction under the Rehabilitation of Offenders Act 1974?
YesNo
If yes, please give details below including date of offence

I confirm that the details given in this application are true. I understand that if I have knowingly or recklessly given any false information, or withheld information in connection with this application, my accommodation may be repossessed by virtue of Schedule 2 of the Housing Act 1985 (as amended).

Print Name

Signed

Consent form

I understand that Rockdale Housing Association processes and may share information about me which is essential for delivering my housing and support services.

I understand that Rockdale collects and processes some personal information about me to provide me with accommodation, an enhanced level housing and support services.

What we use your personal data for:

If you contact us about your housing options and/or your housing application we will use your personal data to:

• assess your situation

• contact you about your situation and the information you have provided

• ask you to provide documents to prove your housing circumstances

• contact third parties with your personal information to request further personal information about you

• refer you to third parties and/or other agencies that may be able to help you.

Who we may share your data with

Which third parties and/or other agencies we may refer you to will depend on your personal situation, but may include:

• Social services and related agencies

• NHS medical professionals

• Your doctor or associated doctor's surgery staff

• Housing associations

• Other departments within Rockdale Housing (including members of our Care and Assessment Committee in order to complete assessments)

• The Home Office

This list is not exhaustive, and we may need to use your data to refer you to other third parties and/or other agencies.

Rockdale will seek my explicit consent to process and share personal or sensitive data about me with a third party if it is not deemed essential for the housing application to be assessed.

I understand that I may withdraw my consent to the processing and sharing of my non-essential data at any point and a member of staff will explain any implications associated this decision.