Your Full Name (required) Other names you're known as: Your Email (required) Your telephone / mobile number (required) Your address How long have you lived in Exeter? If less than 6 months, what area did you live in, and for how long? Your Date of Birth How long have you lived in Exeter? malefemalenon-binaryprefer not to say SingleMarriedWidowedDivorcedSeparatedRegistered Partnership National Insurance Number Number of Children If any children, are you responsible for their care? YesNo Next of Kin Could you please tell us the details of aprent or other person we may contact in case of emergency Your present circumstances Your present accommodation Please select the option which best describes your current accomendation situation Renting PrivatelySupported Housing ProjectSupported LodgingsLiving with familyStaying with friends/relatives (Own room)“Sofa-surfing” (sleeping at friends’ houses)Children’s home/foster careIn a B&B or similarRough sleepingLiving in overcrowded accommodationBeing evictedHad to leave home as a result of pressure from other household membersSuffering domestic violence, or fear domestic violenceOther (please explain) Please give details of your present landlord/accommodation provider: Yes, Full AmountPart amountNo Your Present Economic / Work Situation Please selct the option which best descirbes your current work / training situation. Working full time (over 16hrs/week)Working part-time (16hrs or less/week)Full-time studentPart-time studentOn government training schemeRegistered unemployed (universal credit)Registered unemployed (job seekers allowance)Sick/disabled (universal credit)Sick/disabled (ESA) If in education If working If Between Work If you're receiving PIP or DLA, please let us know the following. Do you owe any money to anyone or any company? If yes, please give us full details below. Do you have a debt repayment plant in place? If yes, let us know the name of the person or comapny, how much, and of you're upto date with withe repayment. Δ
