FOR OFFICE USE Information about ONLY: Thames Gateway YMCA Foyer Date received: Supported Housing ------
MISSION STATEMENT: To provide safe and secure accommodation for young people aged 16-25 with support needs. To continue to work both formally and informally with young people, providing opportunities and support, through a personal development plan, to equip them with the skills to enable them to live independently.
Who can Apply: Single young people aged between 16-30 years, although priority is given to those between 18 and 25 years. Applicants must be capable of a basic degree of independent living; in immediate need of housing and seeking employment, training, education and personal/social development.
Application Process: Once you have filled in our application form you will be added to our Applicant’s List and invited for an interview. If you are successful at interview then you will be put on our waiting list and notified when a flat becomes available. Priority is given to those who meet the criteria and have a direct connection with Kent, and who will enable a balanced community to be maintained. Applicants who are not based in Kent can apply but will not be treated as priority.
Type of Accommodation: Thames Gateway YMCA has 46 rooms available. These consist of 22 self-contained bed-sit flats with own kitchen and bathroom and 24 ‘cluster flats’ with their own bathroom and a communal kitchen, which is shared between 8 residents. These flats are partly furnished and there is also a laundry room that can be used by all residents. New residents are normally given a cluster flat when they start their tenancy with the YMCA.
Cost: The weekly rent at Thames Gateway YMCA for a self-contained flat is £129.30 and £120.51 for a Cluster flat. If you are employed full-time then you will have to pay this in full and arrange your Council Tax payments. If you receive benefits then you can claim Housing Benefit, which will cover the majority of your rent, leaving you with a small Personal Rent Charge. If you are on a low income then Housing Benefit may also be able to help you with some of your rent. Please talk to staff if you wish to inquire about eligibility for Housing Benefit.
Objective: Thames Gateway YMCA aims to provide supported housing to those who meet our criteria and need support to enable them to make the transition from dependence to independent living.
Support Offered: Thames Gateway YMCA accommodates people with low support needs for up to two years. We assess individual’s support needs at an interview with two members of staff and if they move in then we agree and set up a Support Plan which is reviewed every three months. Tenants are required to meet regularly with their support worker and accept support and training offered.
PLEASE ENSURE THAT YOU READ AND SIGN THE DECLARATION AT THE END OF THIS FORM. THE YMCA CANNOT PROCESS YOUR APPLICATION FOR HOUSING IF THE DECLARATION IS NOT SIGNED, THANK YOU. Section 1 Your personal details: Full name:
Date of Birth: Gender: Male / Female National Insurance No: Your contact details: We use this information to contact you about your application for accommodation at the YMCA. If you can, please provide two phone numbers where you can be contacted, one of them can be the number of a someone you trust. Contact Address:
Alternative Contact no: contact no: Email address
Your next of kin: Full name: Mr / Mrs / Miss / Ms Contact Address:
Relationship: Telephone No:
Please describe the connection you have with the Dartford area:
Your medical details: Doctor’s name: Address:
Telephone No: Please provide details of any current disabilities or illnesses / medication you take:
Do you require accommodation design for wheelchair use? Yes: No:
Section 2 CRIMINAL CONVICTIONS AND ARRESTS
THIS SECTION MUST BE COMPLETED, WITH DETAILS IF APPLICABLE.
A criminal conviction does not necessarily prevent you from obtaining accommodation, but certain offences may render the application unsuitable
Do you have any criminal convictions or cautions? Yes: No: Have you ever been arrested? Yes: No: (please tick yes even if you were not charged with any offence) IMPORTANT: PLEASE GIVE DETAILS OF ANY CONVICTION OR ARREST, INCLUDING DATES. This is your opportunity to explain what happened.
May we run your details past our Police Liaison Officer? Yes: No:
ESSENTIAL SUPPORT INFORMATION This section must be completed, with details if applicable
Do you have a history of problems relating to drugs? Yes: No:
Do you have a history of problems relating to alcohol? Yes: No:
Do you have a history of problems relating to gambling? Yes: No: IMPORTANT: PLEASE GIVE DETAILS INCLUDING DATES . Section 3 About your circumstances:
Working full-time Working part-time Government Training (16+ hrs/wk): (less than16 hrs/wk): Scheme:
Full-time student: Voluntary work: Full care order: Registered Not seeking Permanently sick / unemployed: employment: Disabled: Refugee / Other:______Asylum Seeker:
What is your total weekly income after Tax and N.I. deductions? £
Does any of your income come from State Benefits? Yes: No: Where you currently live: Renting from a Renting Renting from a Housing provided local authority: privately: Housing Assoc: with your job: Owning or Living with friends In a long-stay Other:______buying a home: or family: institution:
How long have you lived at your present address? Your reason for applying:
Current housing is Breakdown of Discharged from Attending local overcrowded: relationship: Long Stay Inst. : College: Current housing in Experiencing Financial Moving to poor condition: harassment: difficulties: new job: Current housing is Experiencing Health / Medical Seeking shared: physical abuse: reasons: independence: Current housing is Pressure to leave Need for warden To be near family / temporary: home: support: friends: Being evicted from Other: ______current housing:
About the YMCA: Have you applied to this YMCA before? Yes: No: If Yes, please state when:
Have you lived at this or any other YMCA before? Yes: No: If Yes, please state which YMCA and which dates:
Do you have any friends or relations living at this YMCA? Yes: No: If Yes, please state their names: About your Qualifications:
Do you have a GCSE in Maths? Yes: No:
Do you have a GCSE in English? Yes: No: What other qualifications do you have?
About your family/friends:
Are you in contact with your family? Yes: No:
Do they live locally? Yes: No:
Can we contact your family for a character reference? Yes: No: If yes, please give their contact details:
About your faith/culture:
Do you have any needs in relation to your faith or culture? Yes: No: If yes, how are these currently being met?
The Foyer Community: This foyer community is a diversity of cultures, backgrounds, males and females living in close proximity to each other. With this in mid please tell us what you think would make a good tenant and what you feel you could bring to this community?
Section 4 NEEDS ASSESSMENT SHEET Please tick the boxes as to how you would grade your support need in each of the areas. Any Problems with:
Level of Help Needed None Low L-M Med M-H High Agency Contact: Communication
Reading
Writing
Budgeting
Claiming Benefits
Motivation
Boredom
Anger/Stress Management
Self Confidence
Social Interaction
Training
Self Esteem
Employment
Unemployment
Cleanliness - personal
Cleanliness – of home
Crime
Illegal Drugs
Cooking
Family
Filling in Forms
Keeping Appointments
Faith/Culture
Other Issues:
Section 5 Questions for Equal Opportunities/Statistical Purposes Your marital status: Single: Married: Separated: Divorced:
Your Ethnic Origin Please tick most appropriate White: Mixed: Asian or Black or Chinese or Asian British: Black British: other: British □ White and Black Indian □ Caribbean □ Chinese □ Caribbean □ Irish □ White and Black Pakistani □ African □ Other □ African □ Other □ White and Asian □ Bangladeshi □ Other □ Other □ Other □ Your Religion: Christian: Other: Catholic □ Muslim □ Atheist □ Protestant □ Sikh □ Agnostic □ Baptist □ Hindu □ None □ Methodist □ Buddhist □ Refuse to answer □ Other □ Other □
Sexuality (for statistical purposes): Heterosexual □ Homosexual □ Undecided/Unsure □ Other □ Refuse to answer □
How did you hear about the YMCA: Social . Citizens Probation Self- Church / Other: Services: Dartford Borough Advice Services: referral: ______ Council: Bureau:
Section 6
Your References: Please provide contact details for two independent referees. One of which should be a professional for example; a teacher, doctor, housing support worker, Connexions worker, counsellor, social worker, probation officer, YOT worker, mental health worker. If you have not had a landlord before, then please give details of a past employer, or if you cannot provide either of these, then please provide a referee that is not related to you as a character reference.
Professional Reference(e.g. advisor, Landlord or Character reference teacher, employer, social worker)
Name: Name:
Position: Position:
Address: Address:
Telephone: Telephone:
Please read and sign the declaration overleaf.
Section 7
In signing below, I give permission for Support Staff at the YMCA to contact a Police Liaison Officer in order to conduct a police check in accordance with the Kent Information Sharing Agreement. I understand that if, I am refused housing at the YMCA due to an unsatisfactory police check, I will not be permitted to enter YMCA Thamesgateway premises to visit residents, attend YMCA Youth Club or any recreational activities which take place at the Roundhouse with the exception of; pre-arranged appointments for any programme of personal development that takes place in The Roundhouse.
In signing this form, I declare that the information contained in this form is true and accurate to the best of my knowledge
IMPORTANT: IF YOU DO NOT SIGN BELOW YOUR APPLICATION CANNOT PROGRESS ANY FURTHER. Declaration:
I declare that to the best of my knowledge the information I have provided is true and complete and that I give consent for the YMCA to conduct a police check in line with the Kent Information Sharing Agreement. I will inform Dartford YMCA if my circumstances change.
------
Signed: Dated:
Any false declaration may result in your application being disqualified.
Publicity: The Dartford YMCA may wish to use your photograph in publicity material, please tick the box if you object to your photograph being used in this way:
Please return this form to:
Dartford YMCA, The Roundhouse, Overy Street, Dartford, DA1 1UP
What Happens next?
Please tear off this sheet and keep it 1) The YMCA will ask for a police check to be done, this usually takes at least a couple of weeks. Everyone gets a police check so if you are offered a flat here you know that you will be safe.
2) If your police check comes back OK we will invite you in for an informal interview. We will use the mobile number you have given us on your form to contact you to book the interview.
IMPORTANT: IF YOU CHANGE YOUR MOBILE NUMBER IT IS ESSENTIAL THAT YOU TELL US.
IF you get a call from 01322 282030 or 01322 282045, it is the YMCA, please answer it or call us back.
3) If you are invited for interview please bring some ID and proof of income for example, a benefits letter, a wage slip or a bank statement.
4) If you have any questions about your application please pop in and see us or give us a call on 01322 282045, we will be happy to help
The Housing Team