Borders CHOICE•HOMES www.homehunt.info

Borders Choice Homes Specific Need to be in a Community Application Form Priority for a Specific Need to be in a Community is awarded at Bronze level.

You may qualify for Bronze Priority if:

 You need to move to a specific area to provide or receive care and support

 You are having difficulty accessing essential services

Before applying for a priority in this category please check that your need to be in a community is not covered by one of the other priority. For example if you need to move to a community to receive care and support you can complete a Unified Health Assessment Application.

In order to assess your Specific Need to be in a Community Priority application, please complete form in full.

APPLICATION BCH Registration Number

Name:______

Address ______

______

Telephone: Home ______Work______Mobile______

How long have you lived at your current address: ____ years ____ months

Previous address:______

______

Why did you leave your previous address:______

______

______

Do you have access to a car that you can drive: YES NO

Do you need to move to access essential services: YES NO

What type of services do you require to access and how often:

Do you need to move to provide / or receive support? YES NO Please provide details of support:

Relationship to you______

Name ______

Address ______

Telephone ______

What type of Care and Support are you able to provide:______

______

Please sign here ______Date______

I confirm that the information I have given is correct and that I have not supplied any false or misleading information. I agree to the use of this information in accordance with the data protection notice as stated in the ‘Guide to Borders Choice Homes’ booklet.

PLEASE TICK WHICH AREAS YOU WOULD LIKE YOUR PASS TO COVER You must apply for ALL suitable properties in the areas chosen or your priority will be removed after 6 months (please see the BCH Guide Booklet for more information on priority)

Coldstream Area Eyemouth Area Galashiels Area Cont. Kelso Area  Birgham  Ayton  Lauder  Heiton  Coldstream  Cockburnspath  Melrose  Kelso  Eccles  Coldingham  Newstead  Morebattle  Gordon  Eyemouth Deanhead  Newtown St Boswells  Stichill  Greenlaw  Eyemouth Gunsgreen  St Boswells  Town Yetholm  Hume  Eyemouth Old Town  Tweedbank  Leitholm  Foulden Peebles Area  Swinton  Burnmouth Hawick Area  Broughton  Whitsome  Grantshouse  Bonchester Bridge  Cardrona  Hutton  Denholm  Eddleston Duns Area  Lower Burnmouth  Hawick Burnfoot  Innerleithen  Allanton  Paxton  Hawick Central  Peebles  Chirnside  Reston  Hawick Silverbuthall/  Skirling  Cranshaws  St Abbs Stirches  West Linton  Duns  Upper Burnmouth  Hawick West End  Walkerburn  Gavinton  Hawick Wilton  Longformacus Galashiels Area  Newcastleton Selkirk Area  Preston  Clovenfords  Bowden/Lindean  Westruther  Earlston Jedburgh Area  Ettrickbridge  Stow  Ancrum  Lilliesleaf  Galashiels Central  Jedburgh  Selkirk  Galashiels /Langlee/  Oxnam  Yarrowford Haliburton  Galashiels Torwoodlee

Sheltered Housing Developments If you have indicated a Sheltered Housing Requirement on your registration, please tick to choose the Developments you wish your pass to apply to.  Coldstream, Gowanea Court  Hawick, Douglas Haig Court  Duns, Boston Court  Hawick, Frank Scott Court  Eyemouth, Linkim Court/Swan Court  Hawick, Teviot Court  Galashiels, Abbotsford Court  Melrose, Millar House  Galashiels, Oakwood Park  Peebles, Riverside House