Accessible Housing Referral Form

Thank you for your interest in the Aspire Housing Programme. To see our current vacancies, please go to www.aspire.org.uk/housing-vacancies. If you wish to make a referral, please ensure you complete all sections of this form.

Name of person completing form (required)

Contact number (required)

Contact email (required)

Property/ies you are interested in (required)

Requested move-in date (required)

Discharge date (if applicable)

Name of prospective tenant (if different from above)

Aspire properties are let on a temporary basis to individuals with a spinal cord injury. We issue an assured shorthold tenancy for six months, giving the tenant time to find permanent accommodation. We therefore cannot accept a referral without confirmation of an exit strategy.

Exit strategy of prospective tenant: (required)

Other

* If the prospective tenant is purchasing a new property, do they tenant need to sell a property first?

* If the prospective tenant is seeking accommodation through the Housing Register we will require written confirmation that:
• The Local Authority will retain responsibility for housing them should they take up a temporary tenancy with Aspire.
• Their priority will be unaffected by taking up a temporary tenancy with Aspire.
• The Local Authority consent to them moving temporarily out of area (if applicable) and that this will not affect their priority.

How does the prospective tenant intend to pay their rent? (required)

Other - please specify below

Is care required? (required)

Is the care package in place? (required)

Has a care plan been agreed? (required)

If you’d like to give us more details regarding the care situation please do so below:

Does/will a third party have Power of Attorney or is there a deputy in place? (required)

If yes please specify:

We do not provide or support with arranging care. We ask that the appropriate discharge co-ordinators, Social Workers and/or CHC providers arrange this and keep us informed at to possible start dates for tenancy/discharge purposes.

In order to fulfil our obligations to our partner Housing Associations, we need to be made aware of any of the following issues. Please tick all that apply:

Prior convictions for arsonSubstance abuse issuesUnsupported mental health issuesHistory of criminal activityWishes to be housed with petsOther - please specify below

Other

As a spinal injury charity, Aspire is only able to house people with a Spinal Cord Injury. Please confirm whether you have a spinal cord injury: (required)

Please confirm your medical condition or level of spinal injury: (required)

Does the prospective tenant require a translator and/or the tenancy documents in a language other than English? (required)

If yes, please specify:

Please confirm that the prospective tenant has the right to reside in the UK, has access to suitable funds, and has the legal right to rent. (required)

I am happy to receive further information from Aspire (required)

I am happy for my details to be shared with Back Up

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