Registration Form

Please read our information sheet before completing this form. It provides details about our almshouses including the criteria for appointment. Please also see our Privacy Policy regarding how we handle your personal data.

Please answer the following questions to register your interest.

Full Name Address How long have you lived at this address? Phone Email Address Date of Birth Are you able to live independently? Please list any care/support needed, how often needed, and how it is provided e.g. agency carers help with daily shower; son help with weekly shopping Please list all the dates you have lived in Dorset e.g. 1952 to 1956 and 2000 to 2012 Do you have family that live in Dorset? If you answered Yes to the above question please give their names and relationship to you. e.g. Jane Smith, Daughter Please state where your family live How long have your family lived there? Do you have any other connection to Dorset? Is your current propery owned or rented? Number of Bedrooms Are you in receipt of Housing Benefit? Do you have any savings or investments over £25,000? If you answered Yes to the above question please give some more details Why do you wish to leave your current accommodation? Please tell us anything else you think may support your registration request How did you hear about us?

When submitting information on this form, Dorchester Almshouses will not use your personal data for any form of marketing or pass your data on to any third party processors. The data provided will solely be used to respond to your query/email that you have submitted. Your data will only be retained for the purposes already mentioned above or until such time as it becomes no longer valid or you specifically request its removal.

Date of Submission

By pressing 'SEND' you are agreeing that the information provided in this form is accurate to the best of your knowledge.