1 Start 2 Complete Do you have a local connection to Selby District and are you struggling to find a home that is suitable and affordable? If yes, we want to hear from you. This form will take no more than 5-10 minutes to complete and could result in the development of a small number of affordable homes for people with a local connection. Name Address Telephone Number Email Where do you live * - Select - Acaster Selby Appleton RoebuckBalneBarkston AshBarlbyBarlowBealBigginBilbroughBirkinBolton PercyBraytonBrothertonBurnBurton SalmonByramCamblesforthCarltonCattertonCawoodChapel Haddlesey Church FentonCliffeColtonCridling StubbsDraxEggboroughEscrickFairburnGateforthGrimstonHambletonHealaughHeckHemingbroughHensallHilamHirst CourtneyKelfieldKellingtonKirk SmeatonKirby Wharf with North MilfordLeadLittle FentonLittle SmeatonMonk FrystonNewlandNewton KymeNorth DuffieldOsgodbyOxtonRiccallRytherSaxtonSelby TownSherburn in ElmetSkipwithSouth MilfordStapletonStreetonStillingfleetStubbs WaldenStuttonTadcasterTemple HirstThorganbyThorpe WilloughbyTowtonUlleskelfWest HaddleseyWhitleyWistowWomersley It is not essential that you provide your contact details, however, if you wish to be informed of future progress please provide your details. Personal data in this survey is confidential to the Rural Housing Enabler Officer and Selby District Council. An anonymised summary of information from this could be made available in the public domain. We will not disclose your personal information to any other organisations or individuals. Local Connection to Selby District Do you fulfil at least one of the following four criteria? (tick all that apply) I live in the District I want to return to the District I have a close family connection with someone who lives in the District (family connection must be a parent, adult son, adult daughter, adult brother or adult sister) I work in the District In my home the following issues are not suitable for the household now (tick all that apply) 1 - I can't afford my current accommodation 2 - Poor quality existing accommodation 3 - Need larger accommodation 4 - Need smaller accommodation 5 - Need to be closer to employment 6 - Need to be closer to a carer or dependent 7 - Current accommodation is not permanent 8 - I am a first time buyer 9 - Want to change tenure (e.g. move from a rented property and enter the property market) 10 - Just want a different property 11 - Setting up home with partner 12- I want a place of my own 13 - Need a physically adapted home If you selected you need a physically adapted property. Please state below which adaptions 1 - Wet room 2 - Wheelchair accessible 3 - Level access Where you live now Which best describes your household? Adult: Single Adult: Couple Family Adults: Sharing a property Other What sort of property do you live in now? * House Bungalow Flat How many bedrooms does your current home have? * 1 bedroom 2 bedrooms 3 bedrooms 4 or more bedrooms What is the tenure of your current home? * Renting from Council or Housing Association Renting from a private landlord Living/rent with family Shared Ownership/Discount Market Sale Homeowner with mortgage Homeowner without mortgage Property tied to employment Future Household What type of accommodation would you require in the next 5 years? House Bungalow Adapted or supported housing Flat What is the minimum number of bedrooms that meets your needs of your household? * 1 bedroom 2 bedrooms 3 bedrooms 4 or more bedrooms Thinking about what your household can afford, which tenures would you consider? (tick all that apply) * 1 - Renting from Council or Housing Association 2 - Renting from a private landlord 3 - Intermediate Housing e.g Shared Ownership, Rent to Buy 4 - Buying on the open market Your Financial Situation Please indicate the total yearly gross COMBINED income of your household including any saving or assets is below £60,000? Yes No Additional Information Are you on the North Yorkshire HomeChoice register (the councils housing register)? (Please tick) Yes No Don't know This is the new way of allocating Council and partner Housing Associations’ rented properties and intermediate housing. Please visit www.northyorkshirehomechoice.org.uk to review properties and register. It is important to be registered on North Yorkshire HomeChoice as if a new housing development is built for local people this register will be considered at part of the allocation process. Please use the space below to express any additional comments relating to the possible delivery of affordable housing for people with a local connection to Selby District Please include what this would mean for you and your circumstances Thank you very much for taking the time to complete this survey. So… what happens now? We will keep the housing needs data anonymous and once a sufficient housing need has been identified, we will look to conduct a parish-wide housing needs survey. This will result in an anonymous report being produced (no personal information is included in this). The report will state the number of homes needed (if any), sizes, and tenure types The results of this survey may be used as evidence to support planning applications for small affordable housing schemes to meet the local housing need. In the event that a new development of affordable homes is built on a rural exception site. Priority will be given to applicants with the greatest local connection. Your personal information is kept on file by the Rural Housing Enabler who, in the event that a scheme is developed, will keep you informed of progress, invite you to any meetings or events and help you through the allocations process. All personal information supplied by you on this form will be processed by the Rural Housing Enabler in accordance with the Data Protection Act 1998.