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Ipstones community garden is coming back to life
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Register of Interest Form
Register of Interest Form
PDRHA Register of Interest Form
Data consent / Holding your information: Please confirm that you consent to emh group ltd obtaining and holding your information
*
As per
our privacy policy
. You can remove consent by contacting us
dataprotection@emh.co.uk
Main applicant's title (Mr, Mrs etc.)
*
Main applicant's forenames
*
Main applicant's surname
*
Joint applicants title
Joint applicants forenames
Joint applicant's surname
Number of children in the household
0
1
2
3
4
5
6
Address name/number
Street
Village
County
Postcode
Main applicant's Telephone number
Main applicant's Email address
*
Main applicant's Date of birth
Joint Applicant Date of Birth
Main Applicant Ethnicity
White: English/Scottish/Welsh/Northern Irish/British
White: Irish
White: Other
Mixed: White & Black Caribbean
Mixed: White & Black African
Mixed: White & Asian
Mixed: Other
Asian: Indian
Asian: Pakistani
Asian: Bangladeshi
Asian: Other
Black: Caribbean
Children's home or foster care
Black: Other
Chinese or other ethnic: Chinese
Chinese or other ethnic: Other
Refused
White: Gypsy/Irish Traveller
Chinese or other ethnic: Arab
Joint Applicant Ethnicity
White: English/Scottish/Welsh/Northern Irish/British
White: Irish
White: Other
Mixed: White & Black Caribbean
Mixed: White & Black African
Mixed: White & Asian
Mixed: Other
Asian: Indian
Asian: Pakistani
Asian: Bangladeshi
Asian: Other
Black: Caribbean
Children's home or foster care
Black: Other
Chinese or other ethnic: Chinese
Chinese or other ethnic: Other
Refused
White: Gypsy/Irish Traveller
Chinese or other ethnic: Arab
Village applying for
*
Alstonefield
Ashover
Bakewell
Baslow
Blythe Bridge
Bonsall
Bradwell
Brailsford
Brassington
Brown Edge
Butterton
Calver
Castleton
Cheddleton
Chinley
Cromford
Cubley
Darley Dale
Earl Sterndale
Edale
Elms View
Elton
Flash
Forsbrook
Holymoorside
Hope
Hulland Ward
Ipstones
Kingsley Holt
Kirk Ireton
Kniveton
Longnor
Low Bradfield
Marston Montgomery
Meerbrook
Over Haddon
Repton
Rowsley
Rudyard
Snelston
Taddington
Tansley
Tean
Two Dales
Warslow
Waterhouses
Wetley Rocks
Winster
Youlgrave
Local Connection Criteria
*
To be placed on our register of interest, the Association does require applicants to meet a strict section 106 local connection criteria. Please select from the following options your connection to the village you are applying for;
I currently live in the village/parish
I used to live in the village/parish
I work in the village/parish
I have close relatives in the village/parish
Please give further details regarding your connection to the village e.g. how long you have lived/worked in the Village/Parish, any close relatives who live in the Village/Parish.
*
Do you wish to rent or buy?:
*
Rent
Buy
Either
Number of bedrooms required
1
2
3
4
Type of property required
Flat
House
Bungalow
Current tenure
(eg. renting with social housing provider, private renting, living with family etc)
Why are you applying for housing
Security check
*
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