Housing FAMILY application 2023
Home Address
Mailing Address 3. Household Information 3.a. List yourself, then all other household members. If required, attach separate sheet for more names.
3b. For each person not born in Canada, please provide the information below:
3c. Do all of the people listed live with you full time right now?
If No , please provide the name of the person(s) and number of days per week they live with you.
3.d. Do you expect the number of people living with you to change in the next 12 months? (e.g., pregnancy, family joining, family leaving, child in care)
If Yes, please explain and provide expected date of household size change.
4. Residency History 4.a. Please provide information on your last three landlords.
4.b. Have any adults (age 19 or older) listed on this application lived with you for less than two years?
If Yes , Please list their name and landlord information for their last three landlords
4.c. Have you or any members of your household ever lived in subsidized housing?
If Yes , provide the following information for all previous subsidized housing
If there is money owing due to a past tenancy, complete the following:
Is there a written repayment schedule in place?
Note: failure to declare past subsidized housing or debts owed to subsidized housing providers may result in cancellation of your application
5. Income and Asset Information
5a. Is anyone in the household receiving income assistance from the Ministry of Housing and Social Development (formerly MEIA)?
If Yes , please complete the table below for each person receiving assistance.
5b. For all other income sources, list gross monthly income (before deductions) for everyone age 19 and older.
5c. For any adult (age 19 or older) with no income, please tell us why there is no income.
5d. List the current value of all assets held by you and members of the household.
Is heat included in the rent?
6.d. Please describe your current living arrangements
6e. Do you have a bathroom?
6f. Do you have a kitchen?
6g. Have you received a legal notice to end tenancy?
6h. If you are NOT under notice to move, please tell us why you want to move.
7. Health and Mobility Information To assist with matching you to housing that best suits your needs, please complete the following questions. If you do not have a health condition or disability go to Section 8.
7a. Do you, or any members of your household, have restrictions with stairs?
7b. Do you, or any members of your household, use a:
7c. Other than mobility concerns, do you, or any members of your household, have a health condition or disability?
How does the health condition or disability described above affect your ability to function in your current housing? Please explain:
8. Housing Preferences/Choices Answers to the questions below will help Columbian Centennial Housing Society match you to suitable units.
8.a. Do you or anyone in your household smoke in your home?
8b. Would you consider housing without parking?
8c. Do you have any pets?
Provide the following information for all household pets.
8d. Tell us where you would like to live.
There are more people applying for housing than vacant units. Therefore, the time to find housing can be very long. To increase the chances of being offered a place to live, you might want to select a number of buildings or areas.
However, please note that if you refuse two offers of housing, your application will be cancelled . For that reason, you must be sure that you are prepared to live in any of the buildings or areas you list.
A maximum of two off ers of housing will be made. If two off ers are refused, your fi le will be cancelled.
Please make sure you are willing to live anywhere listed above.
Application Form Declaration Please read and sign this statement.
I or We declare:
this is my/our application; and
all the information in it is correct and complete to the best of my/our knowledge. I or We authorize:
pursuant to the Freedom of Information and Protection of Privacy Act (the FOI Act), Columbian Centennial
Housing Society to make any inquiries that are necessary to verify the information given in this
application;
pursuant to the FOI Act, any person, corporation or social agency to release to Columbian Centennial Housing
Society any information pertinent to the assessment of my/our application; members of Columbian Centennial Housing Society to receive and exchange with credit bureaus and my/our previous
landlords credit and other information about me/us, to be used in the decision-making process to provide me/us
with housing;
Canada Revenue Agency (CRA) to provide verification of my/our income and details from taxation information; the Canada Pension Plan (CPP) releasing information regarding my/our income and medical information from my/our
application for a CPP disability pension; Ministry of Employment and Income Assistance (MEIA) releasing information to Columbian Centennial Housing
Society regarding my/our income and information from my/our Person with Persistent Multiple Barriers or Person
With Disabilities application. I or We understand: that, in accordance with section 33 (c) of the FOI Act, the information on this application may be shared with
other aff ordable housing providers in order to increase my/our opportunities for rent-geared-to-income housing; that this application is not an agreement on the part of Columbian Centennial Housing Society or its members to
provide me/us with housing; that it is my/our responsibility to tell Columbian Centennial Housing Society of any changes to the information
given in this application and to provide any supporting materials required;
that false information given by me/us may result in my/our application being cancelled from consideration; that if I/we have deliberately worsened my/our current housing situation (e.g., terminated a tenancy for no
reason) that my/our application may not be accepted or my/our current living situation may not be taken into
consideration. Application Form Check List Please review this checklist and make sure that, when this application is sent in, all documents are included.
Missing information will slow down the processing of your application.
Submit your completed application with supporting documents to:
Columbian Centennial Housing Society 1161 Sutherland Avenue , Kelowna, B.C. V1Y 5Y2 Fax: 250-862-8215[email protected]
Identification and proof of status in Canada for all household members.
Proof of current address and rent.
Proof of income and assets. Submit Application