Request for priority where an applicant is moving to receive support

Only complete this form if you are already on the Housing Register


Before you begin


Who can complete this form?

Anyone who is on the Housing Register and who wants to move to receive support from someone who does not live with them can apply for priority. We will only give priority to people whose current housing situation will be improved if they need support and have to move to receive it. 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 or receive the support needed.

Please note that you should not complete this form if you are currently living with the person giving support.


Do I need to provide any supporting evidence?

You do not need to provide evidence when you apply. If we need more information we will ask you for it.

How will you assess my priority?

You need to fill in this form to help us make a decision. If you need help please phone us on 787600. We will refer your case to a housing assessment officer who may contact you to get more information. We will carry out assessments within 10 days of receiving all the information we need.

What will the assessment include?


Before we make a decision on your priority we will consider:
The need for support;
• how far you/they have to travel and how often;
• what transport (public and private) is available;
• how much other support there is; and
• the other commitments of the person giving support

What should I do if my circumstances change?

You need to let the Housing Assessment Team know. They will assess your application again and decide if this will affect your priority.
You need to let us know by completing an online change of circumstances form. We will assess your application again and decide if this will affect your priority.

What can I do if I am unhappy with your decision?

You can appeal against our decision, and we will tell you how when we write to you and let you know what your new priority will be

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 www.berneslaihomes.co.uk
  • 1. About the applicant (You)
  • Your title *

  • Your first name *

  • Your last name *

  • Your address *

  • Your date of birth *

  • Your phone number *

  • Your e-mail address

  • Your application reference number (if known) Only complete this form if you are already on the Housing Register

  • 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

  • 2. About the person you are receiving support from
  • 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? *

  • Does the person who gives you support work? *

  • How many hours a week do they work?

  • What days a week do they work?

  • Tell us the address of their place of work.

  • 3. Your support needs
  • Tell us why you need support *

  • What support do you receive from them now? *

  • What extra support will you get if you moved nearer? *

  • Tell us about any other support you get from any other person/agency (if any), include here the type of support and who gives the support. *

  • Do you receive any of the following?
  • Attendance Allowance *

  • Disabled Living Allowance or PIP *

  • If yes, which rate?

  • Does the person giving you support (or anyone else) receive any benefit allowances for looking after you? *

  • If yes, tell us what allowance they receive.

  • 4. The support you receive
  • Please tick which of the following types of support you currently receive from the person/s you want to move nearer to (tick box all that apply)

  • Do you travel to receive support or does the person who supports you travel to you? *

  • How often do you get support from the person/s you want to move nearer to? *

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

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

  • What difference would it make for the person/people who give you support, if you lived nearer? *

  • Do you get support from anyone else? *

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

  • 5. Upload Documents
  • Use this section to upload information that supports your application for priority. For example a GP’s letter or a letter from the Department of Works and Pensions. To upload this information you can either use a scanner or take a photo with your phone or tablet. Just click the upload button.

    More than one piece of information? Just click the “Add” button after you’ve finished uploading each one. You can upload a maximum of five pieces of evidence.

    If you haven’t got the evidence to upload at this point you can save your form until you have or you can upload it later using our “Document upload e form” which you can find on the Tell Us About it section of our website.
  • Documents of proof

    You can upload the following file types: JPG, PDF, PNG
    Please note if you are going to save this form instead of submitting, you will need to upload your file when you submit.

  • 6. Confirmation
  • 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 www.berneslaihomes.co.uk
  • I confirm I have read and understood the form information. *

  • I confirm that I am already on the housing register. *

  • I confirm that the information I have given is accurate and truthful. *