Tenant Family Application

Purpose of this Form

The purpose of the application form is to collect specifi c information from applicants (the person fi lling out the form) seeking housing in accordance with section 26(c) of the Freedom of Information and Protection of Privacy Act.

Columbian Centennial Housing Society will use this information to:

determine eligibility forsubsidized housing;
assess housing need; and
determine eligibility for geared to income housing rental.

Eligibility

Family Housing – Minor aged children must live with you.

PLEASE NOTE – Contact our office twice a year to keep your application active, and as soon as possible if something changes.

Where do you want to live?

Minor aged children must live with you.

Columbus Terrace

44 Unit 2 storey Townhouses with 2, 3, and 4 bedrooms

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Columbus Place

40 Unit 2 storey Townhouses with 2, 3, and 4 bedrooms

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Columbus Gardens

41 Unit 2 storey Townhouses with 2, 3, and 4 bedrooms

Learn More

Please note that if you refuse two offers of housing, your application will be cancelled.

Applicants may be contacted for more information, which may involve providing supporting documents.

For help with this form, please contact Columbian Centennial Housing Society at 250-862-3206 or [email protected]

Download Housing Family Application Form

The Tenant Application can be submitted by downloading the document above and emailing it to [email protected]. Or by filling in the web application below.

Housing Family Application Form

Housing FAMILY application 2023

1. Applicants

Applicant(s)

Last Name	First Name	Mr. Mrs/Miss Ms.

2. Contact Information

Home Phone

Email Address

Work Phone

Contact Person (optional)

Message Phone

Contact Person Phone

Home Address

Street Address

Province

City

Postal Code

Is Mailing Address different from Home Address?

Mailing Address

Street Address

Province

City

Postal Code

3. Household Information

3.a. List yourself, then all other household members. If required, attach separate sheet for more names.

Household Members

Last Name	First Name	Relationship to Applicant	Birth Date	Age	Sex	Born in Canada?

3b. For each person not born in Canada, please provide the information below:

Person(s) not born in Canada

Name	Date Moved to Canada	Current Status in Canada	Name of Sponsor	Date sponsorship agreement started

3c. Do all of the people listed live with you full time right now?

Yes

If No, please provide the name of the person(s) and number of days per week they live with you.

Person(s) not living full time with Tenant

Name	# days per week	Shared custody?	If not shared custody, why are they not living with you full time?

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)

Yes

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.

Tenant last three landlords

Rental Address	From Date	To Date	Landlord Name	Landlord Phone No.	Reason for Leaving

4.b. Have any adults (age 19 or older) listed on this application lived with you for less than two years?

Yes

If Yes, Please list their name and landlord information for their last three landlords

Las three landlords of person(s) living with Tenant for less than two years.

Rental Address	From Date	To Date	Landlord Name	Landlord Phone No.	Reason for Leaving

4.c. Have you or any members of your household ever lived in subsidized housing?

Yes

If Yes, provide the following information for all previous subsidized housing

Subsidized housing

Name on Tenancy	Name and Address of Development	Reason for Leaving	Money Owing?

If there is money owing due to a past tenancy, complete the following:

How much is owing?

Is there a written repayment schedule in place?

Yes

If Yes, please attach a copy of the repayment agreement.

Choose File

Reason for debt:

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)?

Yes

If Yes, please complete the table below for each person receiving assistance.

Person(s) receiving assistance from the Ministry of Housing and Social Development (formerly MEIA)

First Name	Amount

5b. For all other income sources, list gross monthly income (before deductions) for everyone age 19 and older.

Gross Monthly Income (before deductions) for everyone age 19 and older.

First Name	Income Source	Gross Monthly Income

Total gross monthly income for household

5c. For any adult (age 19 or older) with no income, please tell us why there is no income.

If any adult (age 19 or older) is a full–time student, attach proof of student status to application.

Choose File

5d. List the current value of all assets held by you and members of the household.

Cash/Bank Balance

Residential Real Estate

RRSPs/Annuities

Other Real Estate Holdings

Stocks/Bonds/Term Deposits

Other Assets

Proof of income and assets must be sent in with application. See enclosed checklist for details.

Choose File

6. Current Accommodation

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?

No restrictions

Cannot manage stairs

Limited number of stairs

Limited number of stairs. How many?

7b. Do you, or any members of your household, use a:

Wheelchair?

Yes

Who?

Scooter?

Yes

Who?

7c. Other than mobility concerns, do you, or any members of your household, have a health condition or disability?

Yes

Person(s) with health condition or disability (other than mobility concerns)

Name of household member	Explain the 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?

Yes

8b. Would you consider housing without parking?

Yes

8c. Do you have any pets?

Yes

If Yes, how many pets in total?

Provide the following information for all household pets.

Household pets

Type	How many	Breeds	Willing to give up?

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.

Buildings

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.

I have read and agree to the declaration statement above. The Application must be agreed upon by everyone aged 19 or older.

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.


Copy of Canadian birth certifi cate(s) for all family members born in Canada;
For family members not born in Canada, copies of citizenship papers or immigration documents. Acceptable proof includes copies of: Record of Landing (IMM1000); or Sponsorship Undertaking: Confirmation of Permanent Residence (IMM5292); or Permanent Resident Card (both sides).

Proof of current address and rent.


Copy of current rent receipt or recent rent increase notice; or
Copy of lease or tenancy agreement showing current rent amount.

Proof of income and assets.


If receiving income assistance from the Ministry of Employment and Income Assistance (MEIA): copy of cheque stub or confi rmation of monthly assistance from your worker at MEIA.
If employed: proof of current gross monthly income (last three consecutive cheque stubs or letter from employer).
Copies of cheque stubs, bank statements showing direct deposit of pensions, or other confi rmation of income for any other income source.
Copies of bank statements or letter from fi nancial institution stating total value of asset(s).
Property tax assessments for value of property owned and proof of outstanding mortgage(s) if you own property.
Proof of student status for adults age 19 or older who are full-time students.
Where money is owed for previous rental housing, a copy of any repayment agreement you have with your past landlord.
Copy of Notice to End Tenancy (if you answered Yes to Question 6g). This must form call the RTB at 604-660-3456 or download it from www.rto.gov.bc.ca.
Optional: Supplemental Application Form only needs to be completed if you wish to receive extra consideration for: homelessness; health condition aff ected by current housing; or fleeing abuse or violence. The Supplemental Application Form is available online at www.bchousing.org, or call The Housing Registry to have a copy sent by mail.