The Roof Friendly Space - Application Form
One application for One applicant. The application must be filled up by the applicant or the helper on behalf with the applicant's consent. The outcome of the application is solely at the discretion of the Roof committee team. For further information, please contact 011-33101080 (WhatsApp) or www.gskl.org
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Email *
Applicant Legal Name (As per passport or Identity Card)  *
Nickname (if any) of the applicant
Are you the helper that filing this application form on behalf of the applicant? *
If you are filing this application on behalf of the applicant, please provide your name and contact number
example: Selena, +6013-8888444
Gender pronouns of the applicant *
Contact number of the applicant  *
If the applicant does not have any contact, please fill up <Contact the Helper>
Identity Card No. / Passport No.  of the applicant *
Nationality of the applicant *
Is the applicant a refugee to Malaysia? *
Does the applicant currently working with incomes *
Current address/location of the applicant *
As detail as possible
Describe the applicant situation and challenge that needs the support from The Roof *
Please outline if the applicant encounters any situations that challenge their life, safety and accommodation needs. The descriptions will be validated by The Roof committee team during the interview process
Target/Request arrival date and time *
Putting a target date and time helps the house manager to prepare the unit in advance and ease the arrival process
MM
/
DD
/
YYYY
Time
:
Target/Request departure date and time *
Putting an estimated period of stay helps the house manager to coordinate the resources and the committee team to review the application. 
MM
/
DD
/
YYYY
Time
:
Does the applicant having any medical conditions (including mental health condition) and required support while staying in The Roof?  *
If you answered YES for the above medical-related question, please describe the medical conditions here
Other supports that needed by the applicant
The Roof generally do not provide supports in cash term. Any supports other than accommodation are subject to the availability of the support team.
Additional Notes
Please add on here if there are any information that will benefit The Roof team for better supporting the applicant
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