Application Form

Supported Sheltered Resident Application Form

Personal Details Name:  
Post Code:
Tel No:

Contact Details Name:  
Relationship to Applicant:
Post Code:
Tel No:
Further Details Status:
Date of Birth:
National Insurance No.:
Which house(s) do you wish to be considered for?
When do you require accommodation?
Have you completed an NIHE Application Form?

Please provide your NIHE number:

Are you currently in receipt of Housing Benefit?

Do you have a Social Worker/Care Manager?

Social Worker/Care Manager Name:
Social Worker/Care Manager Tel No:
Equal Opportunities

We aim to provide fair and equal access to Abbeyfield houses. To achieve this, we monitor the religion, gender and ethnic origin of applicants. This question is optional. It WILL NOT influence the outcome of your applicaation in any way.

Which of the following best describes your ethnic origin?

Regardless of whether we practice religion, most of us in Northern Ireland are seen as either Catholic or Protestant. We are therefore asking you to indicate what best describes your community by selecting one of the following.

Abbeyfield & Wesley will treat personal data in line with General Data Protection Regulation (GDPR) legislation.