Zebra Housing Association

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Info For Residents
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Online Application Form

Please complete all sections. Failure to do so may result in your application being rejected.

Personal Details
Last Name
Other Name
Title
Gender
- Male
- Female
Date of birth
Date Format: DD slash MM slash YYYY
Nationality
Present Address
Postcode
Email
Home Phone
Mobile Phone
Home Country Address
Who will be living with you in ZHA accommodation
(Please note we do not house siblings, parents or friends. Dependants and spouses only)

First Person
Name
Relationship
Date of Birth
Second Person
Name
Relationship
Date of Birth
Third Person
Name
Relationship
Date of Birth
Location Preferred
Please select your preferred location but be aware that we operate a ‘one offer only policy’ and therefore if you refuse an offer you will be removed from the waiting list. Please also be aware that you will not be considered for accommodation which is larger than your needs require.
Location
- Jerome House SW7
- Jeannine House W1
- Sentosa House N1
- Impala House NW1
- Anson N7
How did you hear of ZHA
University / College
Which university/college are you attending
Title of course/degree
When does this course start
When does this course end
ACCOMMODATION REQUIRED
(All ZHA properties are let for a minimum of six months)
When do you require accommodation
How long do you require accommodation
Size of accommodation preferred
- Single room
- Double room
- Studio
- 1 bed flat
- 2 bed flat
Notice required at present address
Do you have a disability or particular requirement
Income
Monthly Income
Where does this come from
Your monthly budget for rent
Equality and Diversity Monitoring
Zebra Housing Association strives to operate a policy of equality and diversity and not discriminate against any person. For this reason we monitor all aspects of our business including who serves on our Board. The information you provide will be treated in the strictest confidence. The information is reported to our regulator and forms part of an annual report to the Board – see the Equality and Diversity policy approved by the Board in November 2009 and amended in September 2012.
Ethnic Origin
- White: British
- White: Irish
- White: Any Other
- Black or Black British: Caribbean
- Black or Black British: African
- Black or Black British: Any Other
- Mixed: White and Black Caribbean
- Mixed: White and Black African
- Mixed: White and Asian
- Mixed: Any Other
- Asian or Asian British: Indian
- Asian or Asian British: Pakistani
- Asian or Asian British: Bangladeshi
- Asian or Asian British: Any Other
- Other: Chinese
- Other: Any Other Ethnic Group
- I do not wish to disclose my ethnicity
Age Group
- 20-29
- 30-39
- 40-49
- 50-59
- 60-69
- 70-79
- Over 79
Religious Belief
- Atheism
- Buddhism
- Christianity
- Hinduism
- Islam
- Jainism
- Judaism
- Sikhism
- I do not wish to disclose my belief
A person has a disability under the Disability Discrimination Act if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. Long term means has lasted, or is expected to last, for 12 months. Do you consider yourself to be a disabled person.
Disability
- Yes
- No
- I do not wish to disclose
Married/Civil Partnership
- Yes
- No
- I do not wish to disclose
Are you Pregnant
- Yes
- No
- I do not wish to disclose
I confirm that all the information supplied is correct and understand that if it is later found to have been false, I risk losing any accommodation I am offered. I understand that should I cease to be a full time student my application will no longer be valid.

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CONTACT: HOUSING@ZEBRAHOUSING.COM | PRIVACY POLICY | DOWNLOAD 60 YEARS OF ZEBRA HOUSING ASSOCIATION

ZEBRA HOUSING ASSOCIATION LIMITED 5-13 GLENDOWER PLACE LONDON SW7 3DU

PHONE: +44(0)20 7584 2769 FAX: +44(0)20 7589 3648

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