Tenant Apartment Application

Housing APARTMENT application 2023

Which Building would you prefer to live in (mark both if no preference)?

Columbus Centre 1165 Sutherland Ave

Columbus Villa - 1920 Richter Street

Columbus Manor - 1349 Bertram Street

A. Applicants

Applicant(s)

Last Name	First Name	Mr. Mrs/Miss Ms.

Home Phone

Message Phone

Work Phone

Email Address

Address: suite, house number, street, city, province, postal code

B. Household Composition

List yourself on line 1, then list all other persons in your household who will be living with you.

Repeater Field

Full Name	Birth Date	Age	Sex	Relationship to Applicant	Type of Disability (if any)

Wheelchair Requirements

Yes

Do you expect the number of people in your family to change in the next 12 months?

Yes

Please explain:

C. Residency History

(Please list your address(es) for the past 2 years.)

Residency History

Address	From Date	To Date	Name of Landlord	Landlord Phone No.

D. Income Information

(List gross monthly income [before deductions] for all members of your household, age 19 and older, from all sources.)

Income Information

First Name	Source	Gross Monthly Income

Total Gross Monthly Income for Household

E. Current Accommodation

F. Personal References

Personal References

Name	Phone Number	Relationship	Known for how long?

DECLARATION

Please read and sign this statement.

I or We declare:

This is my application; and
All the information provided is correct and complete to the best of my knowledge and

I or We authorize:

Pursuant to the Freedom of Information and Protection of Privacy Act (the FOI Act), the Columbian Centennial Housing Society (CCHS) to make any inquiries that are necessary to verify the information given in this application; and
Pursuant to the FOI Act, any person, corporation, or social agency to release to the CCHS any information pertinent to the assessment of my/our application; and
The CCHS to receive and exchange with credit bureaus and my/our previous landlord’s credit and other information about me/us, to be used in the decision-making process to provide me/us with rental accommodation.

I or We understand:

That this application does not constitute any agreement on the part of the CCHS to provide me/us with rental accommodation; and
That it is my/our responsibility to advise the CCHS of any changes to the information given in this application and to provide any supporting materials required for my/our
That it is my/our responsibility to contact the CCHS every 6 months from the date of this application to maintain an active

I have read and agree to the declaration statement above.

Purpose of this Form

Eligibility

Where do you want to live?

Columbus Centre

Columbus Manor

Columbus Villa

Housing Apartment Application Form