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Your Information

1. Name
2. Date of Birth
3. Address
4. Relationship to the disabled person
5. E-mail
6. Telephone
7. How did you hear about us?
8. Date
9. What is you preferred method of contact? (Please note that the first contact will be by letter unless otherwise agreed upon)

You & your household

1. Who do you live with, and how old are they?
2. Who is disabled, and what is the nature of their disability?
3. Are there any concerns about your / their legal capacity?
4. Yes
   No
   Don't Know
   
5. If Yes, please give details

Your Current House

1. Which local authority area do you live in?
2. Do you own, rent, or have another arrangement?
3. Own
   Rent from private landlord
   Rent from Housing Association
   Shared ownership
   Stay with family and friends
   Live in a residential care setting
   Other
   
4. Is it suitable for you and your household?
5. Yes
   No
   
6. If NO, please indicate why.
7. Access
   Size
   Location
   Wish to live independently
   Other
   
8. Please give details
9. Please describe your current house
10. Would you prefer to remain in your home if it could be adapted?
11. Yes
    No
    
12. Do you want to move?
13. Yes
    No
    
14. Who supports your need to move?
15. Doctor
    Social Worker
    Occupational Therapist
    None
    
16. Who supports your need to adapt your property?
17. Doctor
    Social Worker
    Occupational Therapist
    None
    

Your Finances

1. What is your household's weekly or monthly income from benefits?
2. Which benefits are you claiming?
3. Income Support
   Employment Support Allowance - Contribution based [ES(C)]
   Employment Support Allowance - Income related [ES(IR)]
   Pension Credit (Guarantee Element)
   DLA
   SDA
   Housing Benefit
   Other
   
4. What is your household's monthly income from employment?
5. Is this sum received before or after tax and other deductions?
6. Before
   After
   
7. How much do you have in savings, endowments, or any sums of money available or due to you in the near future?
8. How much IN TOTAL do you owe in debts, loans, rent or mortgage arrears, credit cards etc?
9. Is any of this debt secured against your property?
10. Yes
    No
    
11. If YES, how much?
12. Have you ever been bankrupt?
13. Yes
    No
14. If you currently own your house, how much do you think it is worth?
15. If you currently own your house...
16. How large is your mortgage?
17. Who is the lender?
18. Roughly how much are you still due to pay off?
19. How much, if anything, could friends or family contribute to assist you financially to buy?
20. Would another family member or friend, consider buying a property to let to you if you could repay them with rent through Housing Benefit?

Your need to move.

1. In which area do you want to live?
2. Who would be living with you?
3. How many bedrooms do you need and what features should the house have?
4. Have you registered your housing needs with the Council?
5. Yes No
6. Have you registered your housing needs with any Housing Associations or Co-operatives?
7. Yes No
8. What other steps have you taken to find a suitable home?
9. How much would a suitable house cost to...
10. Buy or build?
11. Rent?

 

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Ownership Options in Scotland is a registered charity (No. SC027335) and is registered in Scotland as a company limited by guarantee (No. SC180581).