Equity House – Kāinga Pai (Orewa)

Autism‑Informed information (Public Housing context)

Purpose: We are using this form to gather information to determine suitability of our imminent housing options for you, autistic person who is eligible for the Public Housing Register. It captures sensory, environmental and support needs to inform matching and reasonable accommodations.

*Eligibility Criteria

I am autistic (diagnosed or undiagnosed) or my accommodation requirements are similar to that of an autistic person(Required.)

Yes

*I am prepared to move to Owera if I am successful(Required.)

Yes

*I am eligible for the social housing register(Required.)

Yes

*I am able to live independently (these units do not have live-in support staff, therefore, tenants need to be able to live alone)(Required.)

Yes

1. Consent and Privacy

I consent to Equity House collecting information for housing support and, with my permission below, sharing relevant details with MSD/Work and Income and housing providers to help with public housing matching. I understand I can withdraw consent at any time.

Full name

Date of birth

MSD client number (if known)

Primary contact number

Email

Consent to share info with MSD/Housing provider

Yes

Preferred communication

Text message/SMS

Phone call

In person

Through support person

Other (please specify)

If you'd prefer for us to communicate through a support person, please provide their name and contact details?

Name

Phone number

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