Name * Email * Mobile Number * Date of Birth National Insurance Number * Gender * -- Select Choice --MaleFemaleOtherPrefer not to say Your Current Address * Support Needed * -- Select Choice --Mental HealthDrugs UseAlcoholPhysicsl HealthAutismOther Are you Claiming Benefits? * YesNo Which Area or Post Codes are you willing to live in Birmingham? * Type of HMO 2 Bedroom3 Bedroom4 Bedroom5 Bedroom6 BedroomAny 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 CreditPersonal Independent PaymentsLimited Capability For WorkCarers Allowance Can Jahn Housing contact you when a room is available? * YesNo I consent to Jahn Housing storing my data in line with GDPR and the Privacy Policy. I consent
