A1 Level 1 : Learning activity 3 : Stage 3 1

MOVING TO A NEW PLACE Homeearchapplicationorm

Please write the first or main applicants surname here Important: Please make sure you read all the information presented in this document carefully before you complete this form.

A. Your details
First name(s) Give any other name(s) you were previously known by Date of birth For example 06/12/1968 Current address Postcode Contact/correspondence or safe address (if different from above) Contact telephone numbers(s) Email address

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A1 Level 1 : Learning activity 3 : Stage 1

Do you experience difficulties with reading or writing? Whats your gender? What is your religion?

Yes

No

Male Prefer not to say Muslim Sikh

Female Buddhist Christian None Hindu Jewish Other

(please specify)

B. Employment information
If you are working, please tell us: What do you do? Yes No

C. Your family or household

We need to know if other people will be moving with you. This will help us to know what type of home you will need. Please give their details below. 1st Last name First name Date of birth Gender Relationship to you (wife, son, etc.) 2nd 3rd

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

D. Your present accommodation/circumstances

Tick the box against the property type in which you live or best describes your circumstances. House Trailer Hostal

Flat/apartment

condominium

Hotel

Bungalow

Cottage

Terraced house

Detached house

Semi-detached house

No fixed address

E. Your house preferences

State your house preferences describing all the characteristics you want your new home to have. House type (apartment, cottage, etc.) Number of rooms Number of bathrooms Which floor (if located in a building) Public utilities (gas, water, etc.) Location Price

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

F. Special requirements
Write a more detailed description of the kind of house you want to have.

G. Applicants signature
Name Date

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.