Make a homeless application form

Your details
1. Please use this form if you have a housing problem, homeless or threatened with homelessness.
  
  Please provide details of your situation and we will try to answer your enquiry.
  
  Due to the complex nature of many housing problems we may contact you to ask further information from you in order to provide a detailed answer.
  
  This service is free and confidential and available only to persons residing in the Preston City Council area.
  
  For more information visit the Housing Advice page.
  
  This form should take under 10 minutes to complete. Please make sure you have details of your housing enquiry available to put in this form.
2. Full Name*
3. Telephone number or Mobile Number*
4. Email address
5. National Insurance Number
6. Date Of Birth*
7. Do you have a fixed address?*
  
  Yes
  
  No
8. You have ticked that you have no fixed address and no address can be supplied.
9. Address line 1
10. Address line 2
11. Town/city
12. Postcode
13. 5 year Address history
  1. We require a 5 year address history, without this information we cannot complete a homelessness assessment.
  2. Have you had any fixed address in the last 5 years?*
    
    Yes
    
    No
    
    . If you answered “yes” then please provide address history.
  3. Address line 1
  4. Address line 2
  5. Town/city
  6. Postcode
  7. The date when you first lived at this address
  8. The date when you left this address
  9. Name of Landlord
  10. Add another address
  11. Address line 1
  12. Address line 2
  13. Town/city
  14. Postcode
  15. The date when you first lived at this address
  16. The date when you left this address
  17. Name of Landlord
  18. Add another address
  19. Address line 1
  20. Address line 2
  21. Town/city
  22. Postcode
  23. The date when you first lived at this address
  24. The date when you left this address
  25. Name of Landlord
  26. Add another address
  27. Address line 1
  28. Address line 2
  29. Town/city
  30. Postcode
  31. The date when you first lived at this address
  32. The date when you left this address
  33. Name of Landlord
  34. Add another address
  35. Address line 1
  36. Address line 2
  37. Town/city
  38. Postcode
  39. The date when you first lived at this address
  40. The date when you left this address
  41. Name of Landlord
  42. Add another address
  43. Address line 1
  44. Address line 2
  45. Town/city
  46. Postcode
  47. The date when you first lived at this address
  48. The date when you left this address
  49. Name of Landlord
  50. Add another address
  51. Address line 1
  52. Address line 2
  53. Town/city
  54. Postcode
  55. The date when you first lived at this address
  56. The date when you left this address
  57. Name of Landlord
  58. Add another address
  59. Address line 1
  60. Address line 2
  61. Town/city
  62. Postcode
  63. The date when you first lived at this address
  64. The date when you left this address
  65. Name of Landlord
  66. Please input any additional addresses and dates to and from at that address and the name of the landlord
15. Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
  
  Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .

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Make a homeless application form