expressions of interest

To submit an expression of interest, please fill out the following form—either by downloading the PDF Version, or by completing the online version to the right.

Contact Details

Title

Mrs

Name*

Address

Telephone

Email Address*

Household Composition

Please provide details of the other people who will live in the property that you are applying for.

Name	Gender	D.O.B.	Relationship
	M F
	M F
	M F
	M F

Current Housing Circumstances

How long have you lived at your current address?
Are you living in subsidised housing (e.g. public or community housing)?
If applicable, what do you pay in weekly rent?
What are the reasons for wanting to move from your current address?

Household Income*

The income thresholds in the table indicate the eligibility criteria for NRAS housing as outlined the federal Government. Please indicate your household type and income threshold by ticking the criteria relating to your circumstances.

Household Type	Initial upper income limit $	Check One
One adult	42,386
2 adults	58,596
3 adults	74,808
4 adults	91,048
Sole parent with 1 child	58,638
Sole parent with 2 children	72,695
Sole parent with 3 children	86,752
Couple with 1 child	72,653
Couple with 2 children	86,710
Couple with 3 children	100,768

Housing Needs

Issue	Yes/No	Please provide details
Does any member of your household have a disability or serious health issue?	Y N
Do you have any special requirements in the type of property you require (e.g. wheelchair accessible, child visitation, prefer ground floor)	Y N
Could your household manage stairs?	Y N
Are you able to live independently without support?	Y N
If you are not able to live independantly, are you currently receiving support?	Y N
Do you have any pets?	Y N
Are you willing to live in a property where pets are not allowed?	Y N

Rent to Buy Option

Eligible tenants will be afforded the opportunity to purchase the property they are renting via a rent to buy scheme. Properties in the rent to buy scheme will become available to purchase within the first 5 years of the tenancy agreement. Up to 30% of total rental paid to the owner will be rebatable to the tenant upon settlement and will help form part of the deposit.

The rent to buy scheme is an option for me

Yes

I wish to receive further information about the rent to buy scheme

Yes

Housing Location

if you are unsuccessful in obtaining tenancy in Casey Gardens, which other locations would you be willing to live in?

List any locations that you specifically do NOT wish to consider:

Privacy Statement

The information requested in this Expression of Interest form is required by Providence Housing Pty Ltd to assess your potential eligibility for housing within the proposed Casey Gardens development. We may also use your information for statistical reports, research, product development and planning. We may disclose your personal information to our associated companies, development partners and professional advisors for the purposes stated above but will not disclose your personal information to anyone else unless required by law. We will take all reasonable steps to protect your personal information from misuse and loss and from unauthorised access, modification or disclosure. We may not be able to properly assess your eligibility for housing within Casey Gardens if insufficient information is provided. You are entitled to access the personal information we may hold about you by writing to us at Providence Housing, Level 19, 500 Collins St, Melbourne 3000.