This form must be attached to the Notification of Vacancy Form – Community Housing

Property vacancy reference	
Property address:	
Unique Property identifier (UPI):	
Nominated applicant’s details	
Application lodged: Yes	No  *	Application number:	
Applicant’s name:	
Applicant’s current address:	
Household size:	Household structure:	
* All applications must be lodged with a Department of Housing and Public Works’ Housing Service Centre.	
Match to transitional housing	
Is the household assessed at very high or high need?	 Yes       No 	
Is the household transitioning from crisis accommodation or any other form of supported housing?	 Yes       No 	
Is the household experiencing homelessness or at risk of homelessness?	 Yes       No 	
Does the household require a specific property type (e.g. accessibility features)?	 Yes        No     	
Other relevant information:
	
Match to property vacancy	
Does the household have a need for housing in this location?	 Yes No		
Do the bedroom entitlements match?	 Yes          No   	
If the response to either of the above is no, why is the household considered a match? 	
Support arrangements for nominated applicant (Transitional housing and Brisbane Common Ground only)	
Is the nomination part of a housing and support arrangement for the applicant?	Yes       No 	
Name of support provider:	
Address of support provider:	
Signature of support provider:	Date:	
Long-term community housing and affordable housing nominations	
Does the applicant match to the property and approved target group?	 Yes       No 	
Does the provider have approval to nominate applicants for this property?	 Yes       No	
Brisbane Common Ground nominations	
Is the nomination for the low to moderate income target group?	Yes       No	
Does the applicant match to the property and approved target group?	Yes       No 	
Authorised by	
Name:	Position:	
Signature	Date	
This form must be attached to the Notification of Vacancy Form and sent to your nearest Housing Service Centre within one (1) working day of becoming aware of a vacancy that is a match to the nominated applicant.

Form ID: CH_NOMF	August 2018– version 2.0