Housing Independence Program application

The Housing Independence Program is a short-term program that helps people without a home get ready to live in stable housing.

Accommodation is offered on a 3-month lease to start with, and people can be part of the program for a maximum period of 12 months.

We develop plans with our customers and help them to:

improve poor rental history
reduce their debts
learn how to be a good customer
access support services
improve their education and employment options.

You must attach the information listed in the checklist below when you lodge your application.

If we don't have all of the information we ask for we won't be able to process your application.

The fields marked with an asterisk – star * are required, all other fields are optional.

Checklist

You need to include proof of all income sources for yourself and each person who lives with you over the age of 18, including:

Centrelink income – you will need to include income statements for the last year or sign the attached Multiple Consent Authority Form, which lets us check your Centrelink Income Statement
salary or wages – you will need to include payslips for last year that show your gross income over this period or fill out the attached wage form
self-employed income – you will need to include one of the following:

a letter from your accountant that verifies your gross income and expenses for the last year

or

a profit and loss statement that has been verified by your accountant for the last year and your lodged tax return and notice of assessment

or

a profit and loss statement that has been lodged with Centrelink for the last year and your lodged tax return and notice of assessment.

Please include proof of any debts, for example: loan repayment statements for the last six weeks.

You need to include proof of identity for all members of your household, for example: drivers licence, birth certificate or passport. You need to give us at least two forms for each member of the household.

Are you without a home or about to become homeless?

Are you eligible for social housing?

Is someone in your household over 18 years of age?

Do you have a regular income or income support?

Are you happy to follow the policies and procedures of the program?

Do you agree to work with Hume employees and other support organisations?

We accept self-referrals, referrals from government and non-government organisations.

For further information contact us on 1800 004 300 and press Option “2” or email us at [email protected].

Title *

First name *

Surname *

Address line 1 *

Address line 2

City *

State *

Postal Code *

Mobile *

Email *

Date of birth *

Nationality *

Resident status *

Country of birth

Main language

Second language

Marital status

Religion

Do you or someone in your family identify as Aboriginal or Torres Strait Islander?

True False

Level of education attained:

Title *

Name *

Address *

Phone *

Relationship *

Do you have an active Pathways Application? *

Yes No

If yes, what is your TFile Number?

Do you have priority housing approval? *

Yes No

Have you been listed as an unsatisfactory tenant? *

Yes No

Are you listed on TICA? *

Yes No

Collapsed tab Household member 1

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 2

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 3

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 4

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 5

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 6

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Collapsed tab Household member 7

Name

Relationship

Date of birth

Gender

Age

Current school or employer

Do you have any pets? *

Yes No

If yes, please explain how many and what sort of animals you have

Do you currently have a support partner?

Are you willing to accept help if we think you need it?

Which of the organisations below are you happy for us to share information with?

Please upload any current pay slips and/or an income statement under the Proof of income checklist option on the first page of this form.

Per fortnight paid by employer *

Per fortnight paid by Centrelink *

Any other income *

Collapsed tab Household member 1

Name

Wages per fortnight ($)