Sharer Application Form

Full Name*

Date of Application*

Phone*

Email*

Date of Birth

Gender
MaleFemaleOther

Primary Occupation

Nationality

Place of Study or Work

Details of Study or Work (days and hours)

Training/Qualifications

How did you hear about Holdsworth HomeShare? Click on the box to select an option.
—Please choose an option—Word of mouthSocial mediaAdvertisementWebsiteEventOther

Why do you want to become involved in Holdsworth HomeShare? Click on the box to select an option.
—Please choose an option—AffordabilityCompanionshipSafetyProximity to work/studyOther

Are you prepared to undergo a Police Check?
YesNo

How long do you want or need accommodation for? Minimum 12months required**

Read and agreed to the Terms and Conditions.
YesNo

I confirm that the information given in this form is true, complete and accurate.
YesNo

I confirm that I will notify Holdsworth if there is any change of circumstances.
YesNo

** Please note the answers to these questions for grant reporting purposes.