Apply for extra care housing

Please provide contact information if you are filling in this form on behalf of someone else

Please provide the contact details for any support provider or social worker who works with you.

Please provide the contact details for any support provider or social worker who works with you.

Declaration and authority to obtain details from another agency. Agreeing to the declaration below means that you agree to the terms and conditions listed in sections 1 and 2. All information provided by either yourself or a third party will be used for the sole purpose of enabling Wigan Council to assess your application for housing in accordance with the Council's Extra Care Housing Allocation Policy and the General Data Protection Regulation 2018.

I understand that Wigan Council will decide whether to nominate me for a tenancy in an Extra Care Housing Scheme based on the information that I have given on this form. The information that I have given is true and correct to the best of my knowledge. I understand that if I give false or misleading information or do not provide relevant information, my application will not be considered. I understand Wigan Council, or any partner agency such as Housing Association can take back any tenancy they have given me if I have provided false information. I will tell Wigan Council if my circumstances change.

I understand that Wigan Council may need to contact other agencies for information about me so they can process my application and assess my suitability to be a tenant in Extra Care Housing. This could include contacting Housing Benefits and Council Tax, other landlords, the Benefits Agency, Probation Service, the Police and Social Services. I give permission for Wigan Council to contact any relevant agencies, including present and/or former landlords. I give these agencies permission to share information they hold on me with Wigan Council so that they can deal with my housing application and any future tenancy. I understand that even if I do not agree to allow this, some information can still be shared to prevent and detect fraud or if it is to stop me committing crime.