APPLICATION FOR PERMISSION TO PARTICIPATE IN THE ROOM FOR A STUDENT – LOCAL AUTHORITY TENANCIES SCHEME Please read carefully and answer all relevant questions. If you have any queries, please contact: housing@galwaycoco.ie

1. Please read the form carefully and answer all questions fully, ensuring all necessary documentation as mentioned below is attached.

2. The person applying for permission to rent a room from a council tenant under this scheme must be a full-time student attending a third level educational institution. The third-level education sector in Ireland consists of universities, institutes of technology, and colleges of education - collectively known as higher education institutions or HEIs. Proof of registration at a higher education institution is required.

3. These forms and declarations set out in Appendix A and B must be completed, signed, and returned to the Council by both the tenant and student applying to participate in the scheme.

4. The forms and declarations should be submitted separately by both the tenant and the student.

5. The application should be made to: Rent a Room Scheme, Galway County Council Áras an Chontae, Prospect Hill, Galway, H91H6KX Email: housing@galwaycoco.ie

6. Failure to submit ALL required documentation with your application or an incomplete application form will result in the application being returned by the Council. The application form will not be considered until such a time as the application and all required documentation is received by the Council.

7. Please note that separate applications are required in respect of each individual student in cases where the tenant intends to rent out more than one room under the scheme.

8. Any permission granted to participate in this scheme is for the duration of one academic 2 year only.

9. The student seeking to rent a room is not authorised to occupy the property until consent is received in writing from the local authority. Failure to comply will result in the application being refused and the student being required to vacate the property immediately. The tenant may also be issued with a tenancy warning for breach of the tenancy agreement.

10. In accordance with the Housing Acts of 1966-2021, the local authority may request and obtain information from another local authority, the Criminal Assets Bureau, An Garda Síochána, the Department of Social Protection, the Health Service Executive (HSE), the Revenue Commissioners or an Approved Housing Body in relation to occupants or prospective occupants of local authority housing. Your data may also be shared with other public bodies in accordance with our obligation to prevent and detect fraud.

11. The Council will consider each application and the decision of the Council will be confirmed in writing to the tenant(s) and student.

12. Please note that the differential rent payable by the tenant(s) will be reviewed following a successful application under this scheme with effect from the date the student has taken up residence in the dwelling as per the signed licence agreement.

13. If approval is granted a licence agreement must be completed and signed by the tenant(s) and the student. A copy must be forwarded to the local authority.

14. Participation by a student in the scheme does not confer tenancy status or any occupancy rights – the student is not a party to the tenancy agreement between the local authority and the tenant and shall have no succession rights in respect of the tenancy.

15. Your rights as a data subject under the General Data Protection Regulation (GDPR) apply in full and will be clearly set out in the relevant data protection policies and procedures for the local authority to whom you are submitting your application. If you have any query in relation to your rights under GDPR, you can contact the nominated Data Protection Officer for that local authority. Details of how to submit your query will be supplied by the local authority directly.

Note: The acceptance of this form by Galway County Council for consideration does not in any way imply that consent has been granted to the applicants to participate. Approval or refusal to reside will be given in writing to the applicant(s).

CHECKLIST

Documents to be included with the Application for Permission to Participate in the Room for a Student – Local Authority Tenancies Scheme

Please ensure that all parts of the application form are complete in full and relevant sections are signed by the Applicant(s) and that the Tenant(s) as appropriate

• Application form • Declaration
• Photo ID i.e. Copy of current Passport/Driving Licence of the student
• Proof of current address for the student
• Proof of enrolment in a Higher Education Institution

Tenant Name

Tenant PPSN

Date of Birth

Contact Phone No.

Tenant Email Address

Eirecode

Property Address:

Is there a joint tenant?

YesNo

Joint Tenant Name

Joint Tenant PPSN

Joint Tenant Date of Birth

Number of bedrooms in the property

Student Email Address

Please give details of all members of the tenants’ household currently resident in the property

How many household members are currently resident in the property?

Name of household member 1

Date of Birth of household member 1

PPSN No. of household member 1

Relationship to Tenant for Household Member 1

Name of household member 2

Date of Birth of household member 2

PPSN No. of household member 2

Relationship to Tenant for Household Member 2

Name of household member 3

PPSN No. of household member 3

Date of Birth of household member 3

Relationship to Tenant for Household Member 3

Name of household member 4

Date of Birth of household member 4

PPSN No. of household member 4

Relationship to Tenant for Household Member 4

Name of household member 5

Date of Birth of household member 5

PPSN No. of household member 5

Relationship to Tenant for Household Member 5

Name of household member 6

Date of Birth of household member 6

PPSN No. of household member 6

Relationship to Tenant for Household Member 6

Name of household member 7

Date of Birth of household member 7

PPSN No. of household member 7

Relationship to Tenant for Household Member 7

Name of household member 8

Date of Birth of household member 8

PPSN No. of household member 8

Relationship to Tenant for Household Member 8

Name of any other student (s) currently renting a room in the property:

What is your and/or other members of your household’s relationship to the student?

Please provide a brief description of the room to be let i.e. single/double, ground floor etc.

Proposed Rent to be charged to the student per week/calendar month €

Is your property specially adapted?

YesNo

Please provide details:

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ROOM FOR A STUDENT – LOCAL AUTHORITY TENANCIES SCHEME

Declaration by Tenant(s)

I/we declare that the information and particulars given by me on this application are true and correct, and I/we understand that the provision of any false or misleading statements may lead to this application being cancelled. Galway County Council reserves the right to exclude an applicant from consideration if they supply false information or withholds relevant information on this form or at any subsequent interviews. I/we undertake to notify Galway County Council immediately should there be any change from the information provided, or in my/our circumstances. I/we authorise Galway County Council to make necessary enquiries either written or otherwise regarding my/our application to verify information given.

I/we declare that I/we will participate in the Social Housing Rent a Room to a Student Scheme in line with the conditions and obligations of the scheme as detailed below:

• That the rent account in respect of the dwelling above is fully paid up to date and no arrears are outstanding.

• That the dwelling above is in good structural condition and is being maintained to a high standard.

• That the dwelling above has sufficient and adequate sanitary, cooking and storage facilities and that all appliances are in working order.

• That the dwelling above is not overcrowded nor would it become overcrowded by means of my participation in this scheme.

• That I/we, or any member of my household, have not engaged in anti-social behaviour nor have I/we ever been subject to a tenancy warning issued by Galway County Council in relation to any breach of my/our tenancy agreement.

• That any disputes that may arise between me/us and the student to whom I/we rent a room are matters between me and the student as the relevant parties and that Galway County Council has no role in the arbitration of any disputes.

• That the student to whom I/we intend to rent a room is not a family member nor do I/we or any member of my/our household have any other relationship with the student.

• That I/we do not keep any restricted dog breeds at the address above.

• That the room(s) being made available by me/us for rent to (a) student shall be made available to the student(s) approved by Galway County Council only.

• That the room will be vacated by the student at the end of the academic year.

• That I/we will comply with the terms and conditions of the Revenue Rent-a-Room Scheme.

I/we confirm that I/we understand that it is an offence under Section 32(7) of the Housing (Miscellaneous Provisions) Act 2009, for me/us to make this declaration if it is false or misleading in any material respect.

PLEASE READ THIS DECLARATION CAREFULLY AND SIGN AND DATE WHEN YOU ARE SATISIFED THAT YOU UNDERSTAND IT

Collection and Use of Personal Data

ALL data supplied by you when completing this form (including any personal data you submit) will be used for the purposes of assessing and administering your application for inclusion in this Scheme. The law allows this local authority in certain circumstances to share your data with other public bodies. For example, we may share your data with the Central Statistics Office under the Statistics Act 1993. In carrying out its functions under the Housing Acts of 1966-2014, the local authority may request and obtain information from other organisations. These include another local authority, the Criminal Assets Bureau, An Garda Síochána, the Department of Social Protection, the Health Service Executive (HSE), the Revenue Commissioners or an Approved Housing Body in relation to current or prospective occupants of, or applicants for, local authority housing. Your data may also be shared with other public bodies in accordance with our obligation to prevent and detect fraud. Your rights as a data subject under the General Data Protection Regulation (GDPR) apply in full and are clearly set out in Galway County Council’s Privacy Statement. Copies of this are available from www.galway.ie If you have any questions about your rights under GDPR, you can contact Galway County Council’s Data Protection Officer, or you may also contact the Data Protection Commission (DPC). For more information, please contact:

Data Protection Officer, Áras an Chontae, Prospect Hill, Galway, H91H6KX / dpo@galwaycoco.ie

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