Priority Pass Application Form - Sustainable Homes

1 Homeless / Unsuitable AccommodationPriority pass Application form Freephone 0800 328 7932 or visit us at Homeless/Unsuitable Accommodation Priority for homelessness or for living in unsuitable property is awarded on the basis of your housing circumstances including: fleeing abuse or harassment, under threat of homelessness, subject to a Repossession Order, staying as a lodger, living in accommodation that is BTS (Below tolerable standard), lacking basic amenities or living in a caravan. If you are homeless or threatened with homelessness you should apply immediately to your local authority (listed below). The council will carry out an assessment and you may be awarded a Priority on the basis of this assessment. Dundee City Council: Lily Walker Centre, 105 Ann Street, Dundee.

2 Tel. No. 01382 432001 or 24hour Homeless Advice Line 0800 633 5843 Fife Council: Home 4 Good Centre, 16 East Burnside, Cupar. Tel. No. 01334 659390 or 0800 028 6231 Angus Council: William Wallace House, Orchard Lane, Forfar. Tel. No. 01307 464966 or Access line 08452 777 778 Perth & Kinross Council: Homeless Advice Centre, 68-86 Scott Street, Perth. Tel. No. 01738 458800 Unsuitable Property this is awarded if you lack basic amenities, have serious disrepair or live in a caravan. If your property is unsuitable and has been declared BTS by the Local Authority you will be awarded a high Priority - Gold pass . If your property is in serious disrepair and lacking 3 or more of the following: no fixed heating source; no private ;no hot and cold water provision; no effective system for drainage and disposal of water; no exclusive cooking facilities you will be awarded a medium Priority Silver pass .

3 If you lack one of the above or live in a caravan you will be awarded a low Priority Bronze pass . If you are awarded a Priority for unsuitable property, you can limit your pass to certain accommodation types or locations (: see list included in information pack). Fixed Heating Private WC Hot & Cold Water Effective drainage/disposal of water Exclusive Cooking Facilities Freephone 0800 328 7932 or visit us at Limiting Your pass : If awarded a pass I would want to limit this to the following locations/types of properties: Locations: _____ Types: _____ Application Registration No. (must be filled in) About You You Name:_____ Your Address:_____ _____ Telephone No:_____(home)_____(mobile) About Your House If you are under threat of homelessness or living in unsuitable accommodation, please give details: _____ _____ _____ Lack of Amenities: (please tick all that apply) Freephone 0800 328 7932 or visit us at Confirmation: I confirm that the information I have given is correct.

4 I have read and understand the Associations Policy in relation to supplying false or misleading information. I agree to the use of this information in accordance with the data protection statement as stated in the Guide to homehunt Caledonia. Signed:_____ Date:_____ Please not we may ask for further information to verify this Application or to visit you at home. When complete and signed, return this for to: Caledonia Housing Association, 118 Strathern Road, Broughty Ferry, Dundee, DD5 1JW Tel: 01382 480915 Fax: 01382 480151 Email.