Expression of interest to be a host for Ukrainian refugees

If you are interested in becoming a host for Ukrainian refugees, please complete the below form and we will be in contact with further information regarding potential matches.

1. About you

Full name

Contact number

Alternative contact number

Email address

Full address

Accommodation for Homes for Ukraine Scheme address (if different from above)

We have been sending out email bulletins with helpful information about supporting Ukrainian refugees. Would you be happy for us to add your email address to this list?

2. Your potential guests

How many Ukrainian guests are you able to accommodate?

How long could you provide accommodation to a guest(s)?

Are you happy to accept a single guest into your property?

To select multiple options, hold down the 'Ctrl' button and click.

Are you happy to accept children into your property?

If you have answered "Yes" to the above question please select from the below age ranges.

Are you happy to accept a guest with a medical need?

Are you happy to accept a non-English speaking guest (or someone with only rudimentary English language skills)?

3. The accommodation you can offer

The accommodation I can offer is shared with my household in our family home.

If yes please complete only the self-contained accommodation section at section 4 below.

4. Shared accommodation (with host family)

How many people, including yourself live in the property?

Please tell us about current work patterns in your household, is there any shift work and does anyone work from home (this is to help us ensure any potential matches are made taking into account your personal circumstances)

What type of property do you have?

If you have answered "Other" to the above question please provide further details.

How many bedrooms are in the whole property?

How many bedrooms can you offer?

How many bathrooms are in the whole property.

Will guests have access to a shared bathroom?

Bath/Shower available.

Do you have any pets?

If yes, please tell us what pets and how many pets you have.

Would you accept pets at the property?

Will guests have access to the lounge area?

Will guests be able to use the Wifi?

Will guests have access to the kitchen?

Will guests have their own food storage space?

Will guests have access to laundry facilities?

If your property has any adaptations for someone with a disability (e.g. walk in shower, wet room, level access, grab rails etc) please detail below.

Will guests have access to outside space (e.g. a garden or balcony)?

Will guests have access to parking if needed?

Is public transport available locally?

If you have answered "Yes" to the above question please tell us more about the type of public transport and the distance from the property.

5. Self Contained Accommodation

What type of property do you have?

If you have answered "Other" to the above question please provide further details.

What is the property usually used for?

Does the property have kitchen facilities?

Are white goods present at the property?

To select multiple options, hold down the 'Ctrl' button and click.

Does the property have laundry facilities?

How many bathrooms are available?

Bath/Shower available.

How many bedrooms are available?

How many single beds can you offer?

How many double beds can you offer?

Is there furniture in the property?

To select multiple options, hold down the 'Ctrl' button and click.

Does the property have Wifi?

Would you accept pets at the property?

If your property has any adaptations for someone with a disability (e.g. walk in shower, wet room, level access, grab rails etc) please detail below.

Does the property have access to outside space (e.g. a garden or balcony)?

Does the property have parking if needed?

Is public transport available locally?

If you have answered "Yes" to the above question please tell us more about the type of public transport and the distance from the property.

How we will use the information provided on this form.

We will only use the information you provide on this form to respond to your enquiry. You have the right to withdraw your consent, if you do we will not be able to continue with your enquiry.

Read our Privacy Policy for further information about how we collect and use your data.

For any data protection queries please contact our Data Protection Officer at dp@havant.gov.uk