Please use this form if you wish to apply to live at a Community Living scheme. Current Your details Spouse/civil partner details Next of kin/Representative details Further information Complete 1 of 5 Name Marital status - Select -SingleMarriedDivorcedWidowed Gender Gender - Select -ManWomanNon-binaryAgender/GenderlessAndrogyne/AndrogynousAporagenderBigenderDemi-agenderDemi-boyDemi-fluidDemi-girlDemi-genderDemi-non-binaryGenderqueerGenderfluxGenderfluidGender-indifferentGender-neutralGraygenderIntergenderMaveriqueMaxigenderMultigender/PolygenderNeutroisPangender/OmnigenderTrigenderTwo-spiritPrefer Not to AnswerOther… Please specify... Date of birth Date of retirement Address Contact number Is the property you currently live in owned by the Church of England? Yes No If yes, is it rented or shared ownership? Rented Shared owner Your position within the Church or relationship to deceased Minister or church worker Your position within the Church or relationship to deceased Minister or church worker - Select -ClergyNon-stipendiary ministerLicensed Lay readerChurch workerWidow/widowerOther… Please specify... Title and name of late partner Their date of birth Are you applying from the United Reformed Church? Yes No Are you applying from the Methodist Church? Yes No Email address National Insurance number
