To test this Waiting List Application request form, please enter your email here - this would normally be your company's email address to which requests for Application forms are forwarded.

Request an Application form for Housing

If you wish to apply for housing, please complete the following form and press Submit when you have finished

If you are currently homeless or about to be made homeless please contact your local housing advice center or local council. We only accept application for housing from people currently resident in Shropshire, with relatives living in Shropshire or with work in Shropshire.

Please enter information for the person you wish us to contact regarding this application

Title:
Mr Mrs Ms Rev Sir
Lastname:

Forenames: please enter in full.

Day Time Telephone Number - if available

Evening Telephone Number - if available

E-mail address - if available

Full Address

Current Tenant?

Information - Please send me information on:

Ethnic Origin - You are not required to give this information if you do not wish to do so. If you do volunteer this information, it will be collectively and anonymously used to monitor equal opportunities. The information provided on this form will be held on computer and is subject to the provisions of the Data Protection Act. Information you have given is confidential and will not be used to discriminate against you in any way, or passed on to any other person or organisation. WHA has an Equal Opportunities Policy and acts according to this statement.

Ethnic Origin:
Asian Carribean SE Asian British/European Combination Irish Other Not Answered
Racial Group:
White Black Mixed Other Not Answered