Thank you for your interest in the Rehome Roots Tiny Home Program. Our mission is to create stable, long-term housing solutions for individuals and families experiencing housing insecurity through our innovative "pay it forward" model.

Please note this is Stage 1 of our application process. We are doing everything we can to meet the incredibly high housing needs that exist currently.

We cannot give you a wait time on when housing will be available. Just by filling out this form you are helping us to help you and others in our community.

Section 1: Personal Information

First Name

Last Name

Date of birth

Phone *

Email *

Address

Street Address

City

State

Country

Postal code

We understand the difficulties in maintaining secure housing during the current housing crisis. Please provide a brief description of your housing arrangements over the past two years or more: share your experiences, challenges, and transitions:

Previous Housing Description *

Additional household members

Name, age, relationship
Name, age, relationship
Name, age, relationship

Are you Aboriginal, and, or Torres Straight Islander?

Yes

No

Prefer not to say

Do you have disability or special needs requirements?

Yes

No

Prefer not to say

Do you have any pets? If yes, please specify type, breed, size.

No
Yes

We want to help you be in a safe place with your pets.

Having pets isn't a disqualifying factor
The program values the bond between people and their pets
The goal is to find housing solutions that work for the entire household

Section 2: HOUSING NEED

Please select all that apply to your current situation *

Displaced by natural disaster

Currently in temporary/emergency housing

Experiencing housing insecurity or at risk of homelessness

Currently spending more than 40% of income on housing

Living in unsafe or substandard conditions

Description of current situation

What date do you need housing

SECTION 3: Personal Statement

Please tell us why you are interested in the Rehome Roots Rent-to-Buy program and how it would help you

Written Description

Why you are interested in the Rehome Roots Rent-to-Buy Program - You have the option to upload a video for all of section 3. Choosing the video option will not effect prioritization of selection

Video Optional

Do you give us permission to use part of your video for promotional purposes? We feel it is important to share the reality of the need for alternative housing options

Yes

No

Are you ready for a 5 year commitment to own your own home and move toward self-sufficiency, and why?

If not, what support would help you get to that point?

What are your dreams and aspirations

How would owning your tiny home as stable housing help you achieve those?

What assistance do you think would help reach those goals?

Section 4: Employment and Income

What repayment frequency would work best for you?

Weekly

Fortnightly

Monthly

What is the maximum payment at the above frequency could you afford in your current situation?

Section 5: Residential History

Do you have a rental history of the past 5 years?

Yes

No

If so, please please provide further information

Rental History

Have you ever been evicted?

Yes

No

Have you ever broken a lease?

Yes

No

Have you had any disputes with neighbours or Landlords?

Yes

No

Please provide two residential references names, telephone and your relationship.

Reference 1
Reference 2

Section 6: Tiny Home Preferences

Do you have access to land to put a tiny home on?

Yes

No

If yes, please provide details below.

Preferred Location A *

Preferred Location B *

Preferred Location C *

Do you have special access needs?

Yes

No

If yes, please provide more information

Rooms Required *

Studio/1 Bed

Two Bedroom

Three Bedroom

Other

Please select the number of rooms

Would you consider sharing land with another person or group of people?

Yes

Yes with conditions

No

Are you happy to share the ownership of the land

Section 7: Lease-To-Buy-Program

Lease To Buy Agreement

I understand that payments include the tiny home rent-to-buy amount, insurance, and land rental costs

I understand that ownership will be transferred to me once the home is paid off.

I understand that my payments help fund homes for future program participants.

I am willing to maintain the tiny home and keep it in good condition.

I understand this is a long-term commitment, 3 to 5 years, possibly more

Section 8: Declaration

By checking the agreement boxes below and entering your name in the signature box, you hereby declare;

Agreement

All information provided in this application is true and correct to the best of my knowledge.

I understand providing false information may result in rejection of my application

I authorise Rehome Roots to verify any information provided in this application

I consent to Rehome Roots conducting reference and background checks

I understand that completing this application does not guarantee acceptance into the program

Signed By

Privacy Statement

Rehome Roots is committed to protecting your privacy. The information collected in this application will only be used to assess your suitability for the rent-to-buy program.