Housing Application Form

Application Form – Jan 26

This application will take around 30-60 minutes to complete, dependent upon the number of applicants/household members. There is no option to save this form to complete another time. Please ensure you have all information to hand including address history, employment and debt details.

Step 1 of 14

Phone

This field is for validation purposes and should be left unchanged.

About you

In this section, we need to capture details about you – the main applicant.

Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number(Required)

Are you a British citizen?(Required)

Yes

Do you have the "Right To Remain" or "Leave to Remain" in the UK?(Required)

I have Right to Remain

I have Leave to Remain

I have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

Please provide further details(Required)

Have you been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

Do you have the "Right to Rent" in the UK?(Required)

Yes

Employment status(Required)

Gender(Required)

What is your gender identity(Required)

Sexuality(Required)

Marital status(Required)

Have you ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

Phone number(Required)

Ideally this would be a mobile phone.

Alternative phone number

For example, a landline number if you already provided your mobile phone number.

Email address(Required)

Enter Email Confirm Email

Nationality(Required)

What is your nationality?(Required)

Ethnicity(Required)

Religion

What is your religion?(Required)

Do you have a disability?(Required)

Yes

Please provide us with more information about your disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

Do you have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements you may need to help you sustain a tenancy.(Required)

Are you pregnant?(Required)

Yes

What is your due date?(Required)

DD slash MM slash YYYY

Is there a joint applicant to add to the application?(Required)

This refers to another adult that will also be named on any tenancy agreements.

Yes

Would you like to add any children to your application?(Required)

Yes

Joint Applicant Details

In this section, please provide details about the joint applicant who will be added to the application.

Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number(Required)

JA. Are they a British citizen?(Required)

Yes

JA. Do they have the "Right To Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

JA. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

JA. Please provide further details(Required)

JA. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

JA. Do they have the "Right to Rent" in the UK?(Required)

Yes

JA. Employment status(Required)

JA. Gender(Required)

What is their gender identity(Required)

Sexuality(Required)

Marital status(Required)

JA. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

Phone number(Required)

Ideally this would be a mobile phone.

Alternative phone number

For example, a landline number if you already provided your mobile phone number.

Email address(Required)

Enter Email Confirm Email

JA. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

JA. Religion

What is their religion?(Required)

JA. Do they have a disability?(Required)

Yes

JA. Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

JA. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

JA. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

Would you like to add any children to your application?(Required)

Yes

Child Details

In this section, please provide details about the first child who will be added to the application. Further children can be added next.

Childs Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number

Do you receive child benefit for this child?(Required)

Yes

C1. Are they a British citizen?(Required)

Yes

C1. Do they have the "Right to Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

C1. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

C1. Please provide further details(Required)

C1. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

C1. Gender(Required)

C1. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

C1. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

C1. Religion

What is their religion?(Required)

C1. Do they have a disability?(Required)

Yes

Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

C1. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

C1. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

C1. Would you like to add any additional children to your application?(Required)

Yes

Child Details

In this section, please provide details about the second child who will be added to the application. Further children can be added next.

Childs Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number

Do you receive child benefit for this child?(Required)

Yes

C2. Are they a British citizen?(Required)

Yes

C2. Do they have the "Right to Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

C2. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

C2. Please provide further details(Required)

C2. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

C2. Gender(Required)

C2. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

C2. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

C2. Religion

What is their religion?(Required)

C2. Do they have a disability?(Required)

Yes

Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

C2. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

C2. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

C2. Would you like to add any additional children to your application?(Required)

Yes

Child Details

In this section, please provide details about the third child who will be added to the application. Further children can be added next.

Childs Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number

Do you receive child benefit for this child?(Required)

Yes

C3. Are they a British citizen?(Required)

Yes

C3. Do they have the "Right to Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

C3. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

C3. Please provide further details(Required)

C3. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

C3. Gender(Required)

C3. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

C3. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

C3. Religion

What is their religion?(Required)

C3. Do they have a disability?(Required)

Yes

Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

C3. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

C3. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

C3. Would you like to add any additional children to your application?(Required)

Yes

Child Details

In this section, please provide details about the fourth child who will be added to the application. Further children can be added next.

Childs Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number

Do you receive child benefit for this child?(Required)

Yes

C4. Are they a British citizen?(Required)

Yes

C4. Do they have the "Right to Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

C4. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

C4. Please provide further details(Required)

C4. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

C4. Gender(Required)

C4. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

C4. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

C4. Religion

What is their religion?(Required)

C4. Do they have a disability?(Required)

Yes

Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

C4. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

C4. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

C4. Would you like to add any additional children to your application?(Required)

Yes

Child Details

In this section, please provide details about the fifth child who will be added to the application. Further children can be added next.

Childs Name(Required)

Title First name Middle name/s Surname

Date of birth(Required)

National Insurance Number

Do you receive child benefit for this child?(Required)

Yes

C5. Are they a British citizen?(Required)

Yes

C5. Do they have the "Right to Remain" or "Leave to Remain" in the UK?(Required)

They have Right to Remain

They have Leave to Remain

They have neither

Unfortunately you are not eligible to apply for housing with EPIC. Please call us on 01782 252575 if you require further clarification on this.

C5. Are there any restrictions on this, or restrictions on recourse to public funds?(Required)

Yes

Not applicable

C5. Please provide further details(Required)

C5. Have they been granted Settled Status (or Pre-Settled Status) by the UK Home Office and can you provide evidence of this?(Required)

Yes

Not applicable

C5. Gender(Required)

C5. Have they ever been known by any other names? For example, maiden names or any other legal name(Required)

Yes

Please give details(Required)

C5. Nationality(Required)

What is their nationality?(Required)

Ethnicity(Required)

C5. Religion

What is their religion?(Required)

C5. Do they have a disability?(Required)

Yes

Please provide us with more information about their disability, including any special requirements you may need.(Required)

We may contact you after we have reviewed your form to ask for further proofs relating to your disability and requirements.

C5. Do they have a vulnerability?(Required)

Yes

Please tell us what is it and any special requirements they may need to help you sustain a tenancy.(Required)

C5. Are they pregnant?(Required)

Yes

What is their due date?(Required)

DD slash MM slash YYYY

If you need to add a further child, please contact us once you have submitted your application form. You can call us on 01782 252575 or email reception@epichousing.co.uk.

Address History

Your current address(Required)

Address line 1 Address line 2 Postcode Country

Which of the following best describes your current living situation?(Required)

Please give details(Required)

Have you lived at your current address for at least 5 years?(Required)

Yes

Date you have lived at this address from(Required)

If you cannot remember the exact dates, please enter as close as possible.

Reason for leaving/wanting to leave(Required)

Please note that under certain circumstances, we may need to visit you at your current address to complete your application.

Please give details of your current landlord, including address and phone number (if applicable)

What notice period do you need to give your current landlord?

Have you had any previous tenancies with EPIC or Bentilee Community Housing?(Required)

Yes

What was the address and when did you live there?(Required)

If you cannot remember the exact dates, please enter as close as possible.

Please provide your address history for the last 5 years, including the landlord details of all rented properties.

A1. Previous address(Required)

Address line 1 Address line 2 Postcode Country

A1. Which of the following best described the living situation?(Required)

A1. Please give details(Required)

A1. When did you live there?(Required)

Please provide the date you moved in and the date you moved out. If you cannot remember the exact dates, please enter as close as possible.

A1. Reason for leaving(Required)

A1. Please give details of the landlord, including address and phone number (if applicable)

A1. Have you lived at any other addresses in the past 5 years other than the above?(Required)

Yes

A2. Second previous address(Required)

Address line 1 Address line 2 Postcode Country

A2. Which of the following best described the living situation?(Required)

A2. Please give details(Required)

A2. When did you live there?(Required)

Please provide the date you moved in and the date you moved out. If you cannot remember the exact dates, please enter as close as possible.

A2. Reason for leaving(Required)

A2. Please give details of the landlord, including address and phone number (if applicable)

A2. Have you lived at any other address in the past 5 years other than the above?(Required)

Yes

A3. Third previous address(Required)

Address line 1 Address line 2 Postcode Country

A3. Which of the following best described the living situation?(Required)

A3. Please give details(Required)

A3. When did you live there?(Required)

Please provide the date you moved in and the date you moved out. If you cannot remember the exact dates, please enter as close as possible.

A3. Reason for leaving(Required)

A3. Please give details of the landlord, including address and phone number (if applicable)

A3. Have you lived at any other address in the past 5 years other than the above?(Required)

Yes

A4. Fourth previous address(Required)

Address line 1 Address line 2 Postcode Country

A4. Which of the following best described the living situation?(Required)

A4. Please give details(Required)

A4. When did you live there?(Required)

Please provide the date you moved in and the date you moved out. If you cannot remember the exact dates, please enter as close as possible.

A4. Reason for leaving(Required)

A4. Please give details of the landlord, including address and phone number (if applicable)

If you need to add any additional addresses that you have lived at in the past 5 years, please contact us once you have submitted your application form. You can call us on 01782 252575 or email reception@epichousing.co.uk.

Does the joint applicant have different address history to you (the main applicant)?

Please answer yes if the joint applicant currently lives separately to you or if they have lived separately to you at any point in the last 5 years.

Yes

Joint Applicant Address History

Joint applicants current address(Required)

Address line 1 Address line 2 Postcode Country

Date the joint applicant lived at this address from(Required)

If you cannot remember the exact dates, please enter as close as possible.

Reason for the joint applicant leaving/wanting to leave(Required)

Please note that under certain circumstances, we may need to visit your joint applicant at their current address to complete your application.

JAA. Has the joint applicant lived at any other addresses in the past 5 years other than the above?(Required)

Yes

JAA2. First previous address(Required)

Address line 1 Address line 2 Postcode Country

JAA1. Which of the following best described the living situation?(Required)

JAA1. Please give details(Required)

JAA1. When did they live there?(Required)

Please provide the date they moved in and the date they moved out. If you cannot remember the exact dates, please enter as close as possible.

JAA1. Reason for leaving(Required)

JAA1. Please give details of the landlord, including address and phone number (if applicable)

JAA1. Has the joint applicant lived at any other address in the past 5 years other than the above?(Required)

Yes

JAA2. Second previous address(Required)

Address line 1 Address line 2 Postcode Country

JAA2. Which of the following best described the living situation?(Required)

JAA2. Please give details(Required)

JAA2. When did they live there?(Required)

Please provide the date they moved in and the date they moved out. If you cannot remember the exact dates, please enter as close as possible.

JAA2. Reason for leaving(Required)

JAA2. Please give details of the landlord, including address and phone number (if applicable)

JAA2. Has the joint applicant lived at any other address in the past 5 years other than the above?(Required)

Yes

JAA3. Second previous address(Required)

Address line 1 Address line 2 Postcode Country

JAA3. Which of the following best described the living situation?(Required)

JAA3. Please give details(Required)

JAA3. When did they live there?(Required)

Please provide the date they moved in and the date they moved out. If you cannot remember the exact dates, please enter as close as possible.

JAA3. Reason for leaving(Required)

JAA3. Please give details of the landlord, including address and phone number (if applicable)

JAA3. Has the joint applicant lived at any other address in the past 5 years other than the above?(Required)

Yes

JAA4. Second previous address(Required)

Address line 1 Address line 2 Postcode Country

JAA4. Which of the following best described the living situation?(Required)

JAA4. Please give details(Required)

JAA4. When did they live there?(Required)

Please provide the date they moved in and the date they moved out. If you cannot remember the exact dates, please enter as close as possible.

JAA4. Reason for leaving(Required)

JAA4. Please give details of the landlord, including address and phone number (if applicable)

If you need to add any additional addresses that they joint applicant has lived at in the past 5 years, please contact us once you have submitted your application form. You can call us on 01782 252575 or email reception@epichousing.co.uk.

You and your money

In this section, we are asking about the main applicant.

Are you currently in employment?(Required)

Yes

What is your job?(Required)

Employer name(Required)

Date you started working there(Required)

DD slash MM slash YYYY

How often are you paid?(Required)

Please specify(Required)

What is your average net income (the amount that you take home) at the above frequency?(Required)

For example, if you get paid weekly, what is your take home pay each week.

Contract type

Do you receive any benefits or other income?(Required)

Yes

Please give details

What is your total monthly income?(Required)

This includes income from working (if applicable) and any benefits you receive.

Do you have a bank account?(Required)

Yes

Do you have any savings?(Required)

Yes

How much do you have in savings?(Required)

Do you own, or have you ever owned, your own home or any other properties?(Required)

Yes

What is the address of the property you own(ed)?(Required)

Do you have any equity?(Required)

This is the value of your home minus what you still owe.

Yes

Please enter the amount.(Required)

Affordability

Applicants must be able to demonstrate that they will be financially able to meet their commitments. All applicants will be required to go through an affordability assessment. Declaration of debt will not stop you from being housed with EPIC, but we need to check that you can afford the home we may offer you. EPIC works alongside a range of partner agencies who can provide debt support and advice to tenants.

Do you or any joint applicants have any debts?(Required)

Yes

Please provide further details of who the debt is owed to and amounts owed.(Required)

If you have a payment plan in place, please let us know how much you pay and how often.

Do you or any joint applicants owe rent for a property you have rented over the last 5 years?(Required)

Yes

How much do you owe?(Required)

Do you have a payment plan in place?(Required)

Yes

Please provide details of the payment plan.(Required)

Do you or any joint applicants have any mortgage arrears?(Required)

Yes

Not applicable

How much do you owe?(Required)

Total debt of you and any joint applicants.

More about you

Do you or any member of your household have any unspent convictions?(Required)

Yes

Please give details.(Required)

Do you have any pending investigations which may result in a charge?(Required)

Yes

Please give details.(Required)

Have you, the joint applicant or any member of your household ever lost a tenancy or been evicted from your home as a result of ASB?(Required)

Yes

Please give details.(Required)

Do you or any member of your household have a current Civil Order, telling you that you should or should not do something?(Required)

Yes

Please give details.(Required)

Are you or any other household member related to anyone who is, or has in the last 12 months, been a Board Trustee or been employed by EPIC?(Required)

Yes

Please give details.(Required)

Your property needs

Are you, the joint applicant or anyone in the household applying for housing on medical/disability grounds, or because the property where you live now is unsuitable?(Required)

Yes

Please give details.(Required)

What type of property do you currently live in?(Required)

Please give details(Required)

How many bedrooms are there at your current home?(Required)

How many reception rooms are there at your current home?(Required)

Reception rooms are living rooms and dining rooms.

Please tell us, in your own words, why you wish to move from your current property.(Required)

For example it is unsuitable for your needs, too large or too small, or has adaptations that you do not require.

If you require a property with a greater number of bedrooms than you would normally be eligible for, or you require a specific type of property, please provide details of any exceptional circumstances to support your request, including any health considerations.

In which areas are you looking for housing?(Required)

Please select all that apply.

Bentilee

Meir

Hanley

Newcastle-under-Lyme

Staffordshire Moorlands

Stoke-on-Trent North

Stoke-on-Trent South

If you have a preferred type of home, please select it below.

Please select all that apply.

House

Bungalow

Flat

Do you have any pets?(Required)

Yes

What type of pet(s) do you have?(Required)

Please select all that apply.

Cat

Dog

Caged animal (including birds)

Fish

Reptile

Other

What type of pet(s) do you have?(Required)

Some of our properties are unsuitable for certain pets. We will only offer you a property that is suitable for you, including any requirements you may have for your pets. Once you have moved into your EPIC home, you will need to request permission for any pets you take on after being allocated the property.

Privacy policy and consent

Do you consent to being contacted via email to complete a feedback survey following submission of this application?(Required)

Your opinion and feedback is important to us. All survey responses will only be used to improve the applicant experience and will in no way impact the outcome of your application.

Yes

Main Applicant Consent(Required)

We are committed to ensuring that the personal data of our tenants (current, former, and future) is handled in accordance with the principles set out in the UK General Data Protection Regulation (GDPR) and The Data Protection Act (DPA) 2018.

Our Privacy Notice tells you what to expect when EPIC collects personal information about you. It applies to applicants for housing, tenants and members of their household, former tenants, visitors to our properties and schemes, and visitors to the EPIC website.

To view our Privacy Notice please click here.

I have read and agree to the Privacy Notice

Joint Applicant Consent(Required)

I have read and agree to the Privacy Notice

Main Applicant Declaration(Required)

EPIC is committed to handling all applications with integrity, and we work closely with our partners to verify the information we receive. Providing accurate information helps us process applications fairly and efficiently.

I confirm that the details I have provided in this form are true and complete to the best of my knowledge. I understand that deliberately providing false or misleading information may lead to action being taken, as fraud is a criminal offence.

I consent to EPIC contacting my current or previous landlords for references about my tenancy history. I also agree that EPIC may share the information in this form with relevant statutory agencies and partner organisations where appropriate.

I understand that if any of my circumstances change, I will notify EPIC as soon as possible.

I confirm that all the information disclosed and recorded in this form is accurate and true.

Joint Applicant Declaration(Required)

I confirm that all the information disclosed and recorded in this form is accurate and true.

Housing Application Form

Application Form – Jan 26

About you

Joint Applicant Details

Child Details

Child Details

Child Details

Child Details

Child Details

Address History

Joint Applicant Address History

You and your money

Affordability

More about you

Your property needs

Privacy policy and consent

Report a Repair

Make a Payment

Performance

Housing Perks App

Complaints & Compliments

Policies & Strategies