SDA Smart Homes Tenancy EOI
Information of prospective tenant
Name
First Name
Last Name
Gender
Female
Male
Age
Email
example@example.com.au
Phone Number
-
Area Code
Phone Number
Current Address
Street Address
City
State / Province
Postal / Zip Code
Primary Contact
If you are completing this form on behalf of another individual please provide your personal contact information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Service provider (if known)
Support Coordinator (if known)
SDA approved in plan?
Yes
No
Unsure
If SDA approved, for which dwelling type? (if known)
Group Home
House
SDA funding level (if known)
Improved livability
Fully Accessible
Robust
High Physical Support
Number of others approved to reside with? (if known)
Address of SDA Smart Home (if known)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Suburb/s? (if any)
Please verify that you are human
*
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I have read and understood SDA Smart Homes privacy Policy
*
YES
please return a copy of this form to sda@propertydirect.com.au
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