starred * questions are mandatory

Sheltered Housing Request

Housing Services have a wide range of housing that can meet the needs of the elderly. If you would like to live in a more supported environment or you are considering sheltered housing as an option for an elderly relative please contact us and we will provide you with information about our services and schemes.

We guarantee to respond to your request within 10 working days and provide you with the type of information that will help you make the right choices about supported housing.

Feel free to contact us for any advice that you may need.
 

Personal details

 
 
Help IconPlease enter details manually if address lies outside the Dudley borough.
 
 

Enquiry details

Is the enquiry for housing for *
Is the enquiry for housing for
 
 
Will anybody else be moving home with the person in question? *
Will anybody else be moving home with the person in question?
 
Please select the areas you are interested in moving to. More than one area can be selected. *
Please select the areas you are interested in moving to. More than one area can be selected.
 

Equality and diversity monitoring

Please tell us a few details about yourself.

This information is very important to us as we will use it to monitor the requests we receive for our services. This will help us to make sure that people are treated in a fair way regardless of their age, gender, race or disability.

The information entered will only be held and used in a statistical format and will not be shared with others. Further information about how we will use this data can be obtained from our Data Quality Officer by telephoning (01384) 815040.
 
I would describe my ethnic group as: *
I would describe my ethnic group as:
 
 
My gender is *
My gender is
 
My age is *
My age is
 
I consider myself to be *
I consider myself to be
 
The Disability Discrimination Act, 1995 defines a "disabled person" as having "a physical or mental impairment which has a substantial or long term adverse effect on their ability to carry out normal day to day activities". It is very important that you declare your disability if you wish to have the protection of the law.
 

Review & submit

Before you submit:

  • Review your completed request
  • Print or save this review copy for your own records, or
  • If you require an email copy of your request, please supply an email address above.
 
Due to the potentially sensitive nature of the equality and diversity monitoring information, it will not be included in the email copy.
 
Yes, I wish to receive an email copy of my request.
 

Data Protection Statement

The information you provide on this form is subject to the provision of the Data Protection Act 1998. The information will be held confidentially and will be retained for the purposes of processing your application and meeting our statutory obligations.

Please refer to our Privacy & Disclaimer Statement below for our Information Charter and general information on our approach to security, confidentiality, data collection, etc.

Further data protection information can be obtained from the Information Commissioner's website at www.ico.gov.uk.
 
 
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