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Tell us about your Vulnerabilities - Permission Form
Your Name - Tenant 1
Your address
I would like STAR Housing to know the following, in order for them to provide their services to meet my needs; please tick all that apply
Please tick all that apply
I have difficulty with my mobility
Please give me extra time to answer the door
I am a wheelchair user
I have some difficulty hearing
Please knock loudly when you visit
I have some difficulty seeing
I am registered blind
Please call before visiting me
I need some help with reading and writing
I have some mental health problems
I have a long term illness
Please use my named Support Workers contact number
Your name - Tenant 2
I would like STAR Housing to know the following, in order for them to provide their services to meet my needs; please tick all that apply
Please tick all that apply
I have difficulties with my mobility
Please give me extra time to answer the door
I am a wheelchair user
I have some difficulty hearing
Please knock loudly when you visit me
I have some difficulty seeing
I am registered blind
Please call before visiting me
I have difficulty with reading and writing
I have some mental health problems
I have a long term illness
Please use my named Support Workers contact number
Name - Occupant 1
I would like STAR Housing to know the following, in order for them to provide their services to meet my needs; please tick all that apply
Please tick all that apply
I have difficulties with my mobility
Please give me extra time to answer the door
I am a wheelchair user
I have some difficulty hearing
Please knock loudly when you visit me
I have some difficulty seeing
I am registered blind
Please call before visiting me
I have difficulty with reading and writing
I have some mental health problems
I have a long term illness
Please use my named Support Workers contact number
Name - Occupant 2
I would like STAR Housing to know the following, in order for them to provide their services to meet my needs; please tick all that apply
Please tick all that apply
I have difficulties with my mobility
Please give me extra time to answer the door
I am a wheelchair user
I have some difficulty hearing
Please knock loudly when you visit me
I have some difficulty seeing
I am registered blind
Please call before visiting me
I have difficulty with reading and writing
I have some mental health problems
I have a long term illness
Please use my named Support Workers contact number
Name - Occupant 3
I would like STAR Housing to know the following, in order for them to provide their services to meet my needs; please tick all that apply
Please tick all that apply
I have difficulties with my mobility
Please give me extra time to answer the door
I am a wheelchair user
I have some difficulty hearing
Please knock loudly when you visit me
I have some difficulty seeing
I am registered blind
Please call before visiting me
I have difficulty with reading and writing
I have some mental health problems
I have a long term illness
Please use my named Support Workers contact number
Signature - Tenant 1
Clear Signature
Our Privacy Notice
I give consent for STAR Housing to hold this information to enable them to provide a service that meets my needs. I understand I can withdraw my consent at any time by writing to STAR Housing.
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