Arataki Transitional Housing Referral Form

Transitional Housing Referral Form

ARATAKI MINISTRIES Ltd
PO BOX 5028, WHANGAREI
(09) 4303044
(09) 4303544
[email protected]

Name(Required)

First Name Surname

Date(Required)

Phone Number(Required)

Email(Required)

Address

Street Address Suburb City Postal Code

Date of Birth(Required)

Ethnicity(Required)

Gender(Required)

Occupation

APPLICANT MUST MEET THE FOLLOWING CRITERIA

1. Applicant must have a current medical mental health diagnosis.(Required)

2. Applicant must be supported by a secondary service – Who?(Required)

(A professional service that will continued to support the applicant for 3 months into a successful tenancy).

3. Applicant must be registered with Social Housing (MSD).(Required)

DO YOU HAVE ANY DEPENDANTS?

(Children or Ward under 18yrs in your care)

DEPENDANTS List

Names

Date of Birth

NEXT OF KIN

(Family/ Friends/ other – in case of an emergencies)

Emergency Contact List(Required)

Name

Contact Number

Address

HOUSING INFORMATION

Have you rented before?(Required)

How long have you lived at your current address?(Required)

Reason for moving from your current situation?

HOUSING NEEDS

What best suits your renting needs?(Required)

Single

Family / Friends

Flatmates

Other

How much weekly rent do you think you can afford?(Required)

Do you smoke cigarettes or vape?(Required)

Yes

Do you own any pets?(Required)

Yes

TENANCY REFERENCE

From a previous Landlord or character references from a person of good standing that has known you for 12 months or more.

TENANCY REFERENCE List(Required)

Referees name

Phone number

Transitional Housing Relevant Files(Required)

Applicants must be HUD Social Housing registered, or it may affect your application/referral

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 2 MB, Max. files: 5.