Apply Online

This form asks for information about you and your household. 

Please fill in this form as fully as you can.  The information you give will help us decide whether or not we are able to rehouse you.   All information in this form will be treated as strictly private and confidential and complies with the Data Protection Act 1998.

If you need assistance completing this form, please ask a member of Regenda staff.

This form is also available in Braille, large print, on tape and in other languages.

Please select the application type you wish to make.

Single Application

Joint Application

Alternatively, download a pdf vesion here for you to print off, complete and send to us in the post.