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Independent Living Application and Self Assessment Form

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Application and Self Assessment Form

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Application and Self Assessment Form

Items marked mandatory must be completed

If you would prefer to print this form and complete it offline please download it from here: You will then need to return it to: Independent Living Applications, Central Bedfordshire Council, Priory House, Monks Walk, Chicksands, Shefford, Bedfordshire, SG17 5TQ

Please ensure you read the following notes and meet the requirements listed

Please note: - This form takes approximately 30-40 minutes to complete, 
and will require financial, medical and support information.

  • You will be asked to provide proof of information given within this form. 
  • Failure to provide this information when requested may delay your application.

To qualify, you need to meet the following criteria:

  • Is everyone on the application aged 55 or over?
  • Live in Central Bedfordshire or have a local connection to the area (as defined by Central Bedfordshire Council's Independent Living Policy)
  • Meet the income criteria as below:
    • Rental: savings of less than £50,000, and an income of less than £25,000 per annum
    • Shared Ownership: income of less than £80,000 per annum
  • Be willing to contribute to the community, and prepared to sign a Community Charter


If you have said yes to all of the above, then you may qualify for one of the Independent Living Schemes in Central Bedfordshire and can continue to complete this application form.

When we receive this form, we may contact you to make an appointment to visit you in your home.