Disabled Persons’ Accommodation Agency
On-line Registration Form
Applicant’s details The applicant does not necessarily need to be the person with a physical disability or sensory impairment - it should be the person to be contacted on any matters concerning the information given on this form or if a possible property becomes available.
Last name
Title
First names
Date of birth
(dd/mm/19yy)
Present address:
Postcode:
Telephone (inc code):
Minicom:
If you are seeking accommodation within the public sector please complete the following table:
Members of Household Please detail everyone who will be living with you, including a carer if you are expecting to have one.
Age
Relationship to you - e.g., son, mother, carer...
Current Housing
Please select the option most that most appropriately describes your circumstances
Owner Occupier Council Tenant Housing Association Tenant Tenant with Private Landlord Living with Parents Other
Physical Impairment
Please click the appropriate box(es)
Sensory impairment
If you have a sensory impairment please select from those listed :
Impaired Hearing Impaired Eyesight Both Hearing and Eyesight impaired
Location
Where would you like to live? Please click the district council areas that you would like to live in. Tick as many as necessary (hold down Ctrl + left click to select more than one area)
Gravesham Dartford Medway Swale Canterbury Thanet Dover Shepway Ashford Tunbridge Wells Tonbridge & Malling Sevenoaks Maidstone ANY AREA
Other (Please specify)
If you wish, name the towns, areas or districts within these areas that you would like to live in. You can be as general or specific as you want to be, but bear in mind that the smaller the area, the more difficult it will be for us to find appropriate accommodation for you:
About your housing requirements:
Select one or more of the following: Rent from Council Rent from Housing Association Rent Privately Purchase a Property Buy/Rent scheme
Are you looking for: Bungalow Flat Detatched Semi-detatched Terraced Maisonette Other (please specify) Sheltered or Supported
If you selected 'Other' please specify
If you wish to purchase a property what price are you prepared to pay? up to £40,000 £40,000 - £50,000 £50,000 - £60,000 £60,000 - £70,000 £70,000 - £80,000 £80,000 - £90,000 £90,000 - £100,000 £100,000 - £125,000 £125,000 - £130,000 £130,000 - £140,000 £140,000 - £150,000 £150,000 - £160,000 £160,000 - £170,000 £170,000 - £185,000 £185,000 - £200,000 £200,000 +
Do you require: Car parking - off road Garage Storage for outdoor electric wheelchair Downstairs lavatory
If you wish to rent please complete the following questions:
Do you have:
Do you have children? This may be relevant to those seeking to rent
Any other information Please give any other information which you would like us to take into account when considering your housing requirements:
For our records The information in this section is only used to help us to monitor the fairness and effectiveness of our service.
Where did you find out about the DPAA ? Advice centre/line Disability group Doctor/nurse Housing Association Hospital Leaflet Landlord Newsletter Occupational Therapist Press Social Services Internet DPAA Staff Word of Mouth Radio/TV Local Council Another source
What is your ethnic origin? Afro-Caribbean African Asian European (white) European (black) Other... please specify
Terms and conditions
Any properties suggested to you through this scheme will not have been Inspected by the Disabled Persons Accommodation Agency. Their inclusion on any lists produced by the Disabled Persons Accommodation Agency dose not mean the premises are recommended by the Agency, or that they are safe or fit for occupation. You must ensure yourself that the premises are safe and fit for occupation. The Disabled Persons Accommodation Agency will not be responsible for any loss you suffer as a result of your property, or goods being destroyed, damaged, or stolen, whilst you are living at one of the properties that you were made aware of by the Agency will be able to find you a new home, but it will improve your chance. Informing the Disabled Person Agency Accommodation Agency of your housing requirements will not guarantee that the Agency will be able to find you a new home, but it will improve your chances, The information supplied on the applied on the application form may be passed on to other organisations that are working with the Disabled Persons Accommodation Agency and who may have a property that could be suitable to the applicant’s needs. The information supplied on the application form will be held on a computer, in compliance with the Data Protection Act 1984.
Any properties suggested to you through this scheme will not have been Inspected by the Disabled Persons Accommodation Agency. Their inclusion on any lists produced by the Disabled Persons Accommodation Agency dose not mean the premises are recommended by the Agency, or that they are safe or fit for occupation. You must ensure yourself that the premises are safe and fit for occupation.
The Disabled Persons Accommodation Agency will not be responsible for any loss you suffer as a result of your property, or goods being destroyed, damaged, or stolen, whilst you are living at one of the properties that you were made aware of by the Agency will be able to find you a new home, but it will improve your chance.
Informing the Disabled Person Agency Accommodation Agency of your housing requirements will not guarantee that the Agency will be able to find you a new home, but it will improve your chances,
The information supplied on the applied on the application form may be passed on to other organisations that are working with the Disabled Persons Accommodation Agency and who may have a property that could be suitable to the applicant’s needs.
The information supplied on the application form will be held on a computer, in compliance with the Data Protection Act 1984.