Application for Rehousing to Give Support

Latest revision date: April 2023
Revision due date: April 2024

Only complete this form if you are already on the Housing Register or you have completed an application form to join the Housing Register.

Who should complete this form?

Anyone who is already on the Housing Register, or has completed an Application Form to join the Housing Register, and who needs to give support to someone who does not live with them. We will award priority to those people whose current housing situation is affecting their ability to give support. This includes where the distance between the home of the person providing the support and the home of the person receiving it affects the ability to give the support needed.

You should not complete this form if you are currently living with the person to whom you give support.

How priority for giving support is assessed

Fill in this form and submit is to us. You do not need to get a letter from your doctor or hospital.

If you need help then telephone us on (01226) 787878 or email

Your case will be referred to a Housing Assessment Officer who may contact you to get more information. The Housing Assessment Officer may also carry out a home visit to ensure that all the necessary information is available to them to make their decision.

We aim to carry out assessments within 10 days of receiving all the information we need and you will be notified of that decision in writing.

What will the assessment include?

We will consider:
• what support is needed;
• how far you have to travel and how often;
• what transport (public and private) is available;
• how much other support there is;
• your other commitments

If your circumstances change

You must let the Housing Assessment Team know by completing a Change of Circumstances Form on the Berneslai Homes website or by telephone to (01226) 787878 or by email to Your application will be reassessed to determine whether the change will affect any priority.

If you disagree wih the decision

You may appeal. You have 6 weeks, from being informed of the decision, to register an appeal. To do this you may complete an on-line Appeal Form, or tell us via an email to or you may telephone the Housing Assessment Team on (01226) 787878.

Protecting your personal data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website

Please note this form only gives you one hour to complete, if you need more time simply click on the ‘SAVE FORM’ button at the end of this form.

  • About the applicant who needs to move to give support
  • Your title *

  • Your first name *

  • Your last name *

  • Your address *

  • Your date of birth *

  • If you supply us with a mobile phone number or email address this will be our method of contact with you.
  • Your phone number *

  • Your e-mail address

  • Your application reference number *

  • Do you work? *

  • How many hours a week do you work?

  • What days of the week do you work?

  • Tell us the address of your place of work

  • About the person you are giving support to
  • Their title *

  • Their first name *

  • Their last name *

  • Their address *

  • Their date of birth *

  • Their phone number *

  • Their e-mail address

  • What is your relationship to them?

  • Who else lives with them?

  • Support needs of the person you are supporting
  • Tell us why this person needs support *

  • What extra support will you be able to give them if you moved nearer? *

  • Tell us about any other support this person currently gets (if any), include here the type of support and who gives the support. *

  • Does the person you give support to receive any of the following:
  • Attendance Allowance *

  • Disability Living Allowance (DLA) or Personal Independence Payments (PIP) *

  • If yes, which rate?

  • Do you or anyone else receive benefit allowances for looking after the person you are giving support to? *

  • If yes, tell us who?

  • The support you give
  • Please tick which of the following types of support you currently give to the person you want to move near to (tick box all that apply) *

  • Please give details:

  • How often do you give support? *

  • Is it you or the person you support who travels to give/receive the support? (tick box) *

  • How do you/they travel? (please tick all that apply) *

  • How far do you/they travel? (Please tick the answer which best describes your journey) *

  • Please tell us what difference it would make to your life if you lived nearer to the person you are supporting? *

  • Do you support anyone else? *

  • Please tell us who they are and what support you give them?

  • Confirmation
  • By ticking the box below, I declare that I fully understand and agree with the following statements:

    - I declare that the information I have given on this form is correct and complete. 

    - I understand that if you later find that I have deliberately supplied false information or omitted to supply information, this can affect my rights to a tenancy and you may take action against me if I am granted a tenancy.

    - I understand that if I have not completed this form fully it may result in a delay in us acting on your request.

    - I understand you may share my information with other agencies to detect and prevent fraud.

    - I confirm that I have already completed a housing application form.
  • *