Applicant form

Tenancy Application

This tenancy application form must be lodged by the applicant. All fields are required except Languages. If you have any questions, please contact us at contact@emmauscommunity.org.au.

01 — Tenant details

Tenant’s first names *

Tenant’s surname *

Tenant’s email *

Tenant’s date of birth (dd/mm/yyyy) *

Tenant’s place of birth *

02 — Contact address

Address Line 1 *

Address Line 2

City *

State or Region *

Zip

03 — Contact phone number

Main contact phone number *

Main contact phone number type *

Do you want to add another contact number?

Second contact phone number *

Second contact phone number type *

04 — Tenancy funding

Tenant’s Income Source *

Does Public Trustee deal with your finances? *

Tenant referred by *

05 — Centrelink and Medicare details

CRN number *

Medicare number *

Medicare reference number *

Medicare expiry month *

Medicare expiry year *

06 — Private medical cover

Do you have ambulance cover? *

07 — Personal history and request

Interests and Hobbies *

Work history *

First language *

Second language

Reasons for wanting long term community living *

Requested Tenancy Commencement *

08 — Tenant’s Next of Kin

Tenant’s Next of Kin’s full name *

Tenant’s relationship to Next of Kin *

Next of Kin’s main contact phone number *

Next of Kin’s main contact number type *

Do you want to add another next of kin’s contact number? *

Next of Kin’s second contact phone number

Next of Kin’s second contact number type

Acknowledgement *

By submitting this form I consent to the release of any information about me, as required by the Administration of Emmaus Community, in order to assess my application for tenancy and assist my living in the Community. All personal information is securely disposed of if applicant doesn’t join Emmaus Community. I understand that this is independent community living and that I must be able to live independently to reside at Emmaus.

You'll find home here.

Creating your sanctuary at Emmaus Community.

Team working in an office watching at a presentation

Applicant form

Tenancy Application

This tenancy application form must be lodged by the applicant. All fields are required except Languages. If you have any questions, please contact us at contact@emmauscommunity.org.au.

01 — Tenant details

Tenant’s first names *

Tenant’s surname *

Tenant’s email *

Tenant’s date of birth (dd/mm/yyyy) *

Tenant’s place of birth *

02 — Contact address

Address Line 1 *

Address Line 2

City *

State or Region *

Zip

03 — Contact phone number

Main contact phone number *

Main contact phone number type *

Do you want to add another contact number?

Second contact phone number *

Second contact phone number type *

04 — Tenancy funding

Tenant’s Income Source *

Does Public Trustee deal with your finances? *

Tenant referred by *

05 — Centrelink and Medicare details

CRN number *

Medicare number *

Medicare reference number *

Medicare expiry month *

Medicare expiry year *

06 — Private medical cover

Do you have ambulance cover? *

07 — Personal history and request

Interests and Hobbies *

Work history *

First language *

Second language

Reasons for wanting long term community living *

Requested Tenancy Commencement *

08 — Tenant’s Next of Kin

Tenant’s Next of Kin’s full name *

Tenant’s relationship to Next of Kin *

Next of Kin’s main contact phone number *

Next of Kin’s main contact number type *

Do you want to add another next of kin’s contact number? *

Next of Kin’s second contact phone number

Next of Kin’s second contact number type

Acknowledgement *

By submitting this form I consent to the release of any information about me, as required by the Administration of Emmaus Community, in order to assess my application for tenancy and assist my living in the Community. All personal information is securely disposed of if applicant doesn’t join Emmaus Community. I understand that this is independent community living and that I must be able to live independently to reside at Emmaus.

You'll find home here.

Creating your sanctuary at Emmaus Community.

Applicant form

Tenancy Application

This tenancy application form must be lodged by the applicant. All fields are required except Languages. If you have any questions, please contact us at contact@emmauscommunity.org.au.

01 — Tenant details

Tenant’s first names *

Tenant’s surname *

Tenant’s email *

Tenant’s date of birth (dd/mm/yyyy) *

Tenant’s place of birth *

02 — Contact address

Address Line 1 *

Address Line 2

City *

State or Region *

Zip

03 — Contact phone number

Main contact phone number *

Main contact phone number type *

Do you want to add another contact number?

Second contact phone number *

Second contact phone number type *

04 — Tenancy funding

Tenant’s Income Source *

Does Public Trustee deal with your finances? *

Tenant referred by *

05 — Centrelink and Medicare details

CRN number *

Medicare number *

Medicare reference number *

Medicare expiry month *

Medicare expiry year *

06 — Private medical cover

Do you have ambulance cover? *

07 — Personal history and request

Interests and Hobbies *

Work history *

First language *

Second language

Reasons for wanting long term community living *

Requested Tenancy Commencement *

08 — Tenant’s Next of Kin

Tenant’s Next of Kin’s full name *

Tenant’s relationship to Next of Kin *

Next of Kin’s main contact phone number *

Next of Kin’s main contact number type *

Do you want to add another next of kin’s contact number? *

Next of Kin’s second contact phone number

Next of Kin’s second contact number type

Acknowledgement *

By submitting this form I consent to the release of any information about me, as required by the Administration of Emmaus Community, in order to assess my application for tenancy and assist my living in the Community. All personal information is securely disposed of if applicant doesn’t join Emmaus Community. I understand that this is independent community living and that I must be able to live independently to reside at Emmaus.

You'll find home here.

Creating your sanctuary at Emmaus Community.

Tenancy Application

Tenancy Application

Tenancy Application

01 — Tenant details

01 — Tenant details

02 — Contact address

02 — Contact address

03 — Contact phone number

03 — Contact phone number

04 — Tenancy funding

04 — Tenancy funding

05 — Centrelink and Medicare details

05 — Centrelink and Medicare details

06 — Private medical cover

06 — Private medical cover

07 — Personal history and request

07 — Personal history and request

08 — Tenant’s Next of Kin

08 — Tenant’s Next of Kin

Acknowledgement *

Acknowledgement *

Submit application

Submit application

You'll find home here.

Tenancy Application

Tenancy Application

Tenancy Application

01 — Tenant details

01 — Tenant details

02 — Contact address

02 — Contact address

03 — Contact phone number

03 — Contact phone number

04 — Tenancy funding

04 — Tenancy funding

05 — Centrelink and Medicare details

05 — Centrelink and Medicare details

06 — Private medical cover

06 — Private medical cover

07 — Personal history and request

07 — Personal history and request

08 — Tenant’s Next of Kin

08 — Tenant’s Next of Kin

Acknowledgement *

Acknowledgement *

Submit application

Submit application

You'll find home here.

Tenancy Application

Tenancy Application

Tenancy Application

01 — Tenant details

01 — Tenant details

02 — Contact address

02 — Contact address

03 — Contact phone number

03 — Contact phone number

04 — Tenancy funding

04 — Tenancy funding

05 — Centrelink and Medicare details

05 — Centrelink and Medicare details

06 — Private medical cover

06 — Private medical cover

07 — Personal history and request

07 — Personal history and request

08 — Tenant’s Next of Kin

08 — Tenant’s Next of Kin

Acknowledgement *

Acknowledgement *

Submit application

Submit application

You'll find home here.