Application Form

Your personal details

First name(s): *
Surname: *
Gender / Preferred pronouns: *

Your gender could be male, female, or whatever other gender you identify as. Your pronouns are how you would like us to refer to you, such as he/him, she/her, they/them, etc.

Date of birth: *
Ethnicity: *
Religion: *
What is your preferred language? *
Do you speak any other languages?
House number/street name: *
Town/city: *
County: *
Postcode: *
Email address: *
Contact phone number: *

Eligibility criteria

Are you currently a home owner?

We will not accept any applications from home owners as this is an affordable housing scheme.

YesNo

Do you currently live, work or intend to work in Stirchley or have family/friends in the area?

We will prioritise applications from those with a local connection.

YesNo

Are you interested in contributing positively to the surrounding area?YesNo

Do you currently own a car or other vehicle that is not required due to a disability?

There will be no parking available in the development. Disabled street parking can be accessed if required.

YesNo

Do you understand that there will be no Right to Buy on any properties in the Stirchley Co-operative Development?YesNo

Do you have a willingness/desire to learn about co-operative living?YesNo

Will you be able to commit some time to the running of the project?

We expect all members to contribute a few hours each month to assist with the running of the co-operative. We will be able to send you more information about this in our membership pack which will be sent to you upon receipt of this expression of interest.

YesNo

About you and your household

What size flat are you applying for?1 bedroom2 bedrooms

Unfortunately, there are no 3-bedroom flats available for this recruitment intake.

If you are planning to share the flat with another adult please enter their name so we can consider your membership together:

Please note that membership of SCD is on an individual basis, so even if you are planning to live together, each adult must fill out their own application for membership. We will take the fact that you are intending to live together into account when considering your individual applications.

Do you have any dependents who will be living with you? If so what are their names and ages?
Do you have any access requirements (e.g. ground floor access needed, hearing aids in meetings, BSL interpretation)?
Do you own any pets?
Do you smoke?YesNo

About your financial situation

Are you working currently? If so what is your rough income level?I'm not workingLess than £10,000£10,000 to £20,000£20,000 to £30,000£30,000 to £40,000More than £40,000
Are you currently claiming housing benefits / universal credit / PIP? If so, which?

Co-op living

Please describe your connection to the local area: *
Why do you want to live in a co-op? *
Have you ever been involved in a co-operative organisation before? *

Don't worry, if you haven't been involved in a co-op before it won't count against you, we're looking for a mix of people who have experience with co-ops and those who don't.

Do you feel that you would have the time and capacity to contribute to the work involved in living in SCD? *
Which working group(s) do you think you might be interested in joining?
AdminFinanceTech & I.T.MembershipUpstairs (housing)Downstairs (worker co-ops)Outdoor spacesPublicity & OutreachSupport & InclusionDemocracy

Housing need

If you are a social housing tenant (i.e. applying for social housing) please tell us which priority band (A, B, C, D) you have been awarded and why.

Please tick any of the following list which apply to you:

We will use this information to create a housing needs score, we may seek clarification and alter your score at the interview stage. If you are a social housing tenant, please still fill out this section as this will help us to treat everyone equally.

I am legally homelessI currently have no fixed abodeI am currently in temporary accommodationI currently have no secure tenancyI am currently living with family / friends (without own tenancy)I am currently housed at a Bed and BreakfastI have a current notice to quit my propertyI have impending homelessness within the next 28 days

I have recently split up with my partner but I am unable to leave our shared accomodationI am currently experiencing domestic abuse (this includes physical, emotional, financial abuse from a current or ex partner or family member you currently live with)I am currently experiencing mental cruelty within my family (whom I am living with)I am currently experiencing harassment by partner, former partner or family member whom I do NOT live withThere is currently a serious risk of violence to my child (under 18)I am currently experiencing violence from a neighbour / friend / community memberI am currently experiencing harassment, including property damage, from a neighbour / friend / community memberI am currently experiencing verbal harassment from a neighbour / friend / community member

I am currently experiencing overcrowding in my property (separate room needed for couple / single parent)I am currently experiencing overcrowding in my property (separate room needed for individual over 18)I am currently experiencing overcrowding in my property (children of opposite sex sharing a room)I am currently experiencing overcrowding in my property (children of same sex with 4 yr age gap sharing a room)I am currently experiencing overcrowding in my property (more than two children sharing a room)I am currently experiencing overcrowding in my property (person 16 years or older sharing a room)I am currently experiencing severe overcrowding (i.e. worse than any of the above)

I am lacking facilities in my current property including (tick all that apply):

No inside toiletNo hot waterNo cooking facilitiesNo space heating (if you are OAP, kids under 13, disabled)No space heating (other)Kitchen shared (with separate household)Bathroom shared (with separate household)

I currently have a notice from Environmental Health (or a health worker has told me) that my property is unfit / unsafe to inhabitThere is a general lack of repair in my current property likely to endanger my healthMy current property is in a poor state of repair and condition

I am part of a family with children currently living in high rise flats (above 3rd floor)I am part of a family with children and my property lacks security / safety for themI am part of a family with children with no garden or safe play area nearbyI am currently pregnant or registered for fostering / adoption and my current accomodation is unsuitable

I am physically unable to maintain my current propertyI am experiencing anti social behaviour from neighbours in my current propertyMy current household environment is adversely affected (e.g. exacerbates health condition) by another person I live with (who is not a partner or family member)I am financially unable to maintain my current propertyI am currently housed a great distance from family / support networkI am currently housed a great distance from my current employment (and need to physically be there)I am currently housed a great distance from training / community / place of worship

I have no access to the Local Authority waiting list due to my immigration status (we will need to see documentation to verify this)I am a care leaver under the age of 25I am approved to adopt, or am being assessed for approval to foster or adopt, and need to move to a larger home to accommodate a looked after child or a child who was previously looked after by the Local AuthorityI am or was previously a member of His Majesty's Armed ForcesThe Council has approved demolition / clearance on my current propertyI am currently in need of or need to provide greater social support for my / my children's needs

I am currently in receipt of disability benefits such as PIP, DLA, ESA or other disablity related benefitsI have a chronic health condition or illness made worse by my current living conditionsI have a chronic health condition or illness with mobility issues made worse by my current living conditions

I have children but we are currently unable to live together due to current housing conditionsI am pregnant or registered for fostering / adoption and my current accommodation is unsuitable for childrenI am unable to live with my family (and wish to) currently due to current housing conditions (no children)

None of the above

Further questions

Is there anything else you would like to tell us about yourself or your household?
Do you have any reservations or concerns about being a member of SCD?
Do you have any further questions about SCD?