Housing Application - Tsawout First Nation

Housing Application Form

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By completing and signing this Application for Social Housing, you are providing Tsawout permission to gather information on you, including your income and assets, and to complete additional checks to assess your capacity to fulfill the Tenant’s obligations under the terms of a Tenancy Agreement. This may include: reference checks, personal interviews or a review of information available from public sources. Applicants who are offered and accept a Rental Unit will be required to sign a Tenancy Agreement with Tsawout.

About You

Your Name(Required)

First Last

Your Address(Required)

Street Address City Province Postal Code

How Can We Reach You?

Preferred Method of Contact(Required)

Your Email Address(Required)

Enter Email Confirm Email

Your Phone(Required)

References

Please enter the contact information for at least three references.

Reference Information

Name	Email or Phone	Relationship to Applicant	Actions

There are no References.

Maximum number of references reached.

Household Information 1/2

Please enter information for each member of your household, include yourself first in this list.

Household Information

Name	Relationship to Applicant	Age	Actions

There are no Occupants.

Maximum number of occupants reached.

Household Information 2/2

Changes expected in next 12 months.

Do you expect the number of people living with you to change in the next 12 months?(Required)

(Ex- Due to pregnancy, family joining, family leaving, child in your care, etc)

Yes

Please Explain(Required)

Do you expect an increase or decrease(Required)

Increase

Decrease

Additional occupants in the next 12 months:

First Name	Last Name	Actions

There are no Occupants.

Maximum number of occupants reached.

Money Owing

Information on outstanding debts.

Do you owe money to Tsawout for any reason?(Required)

Yes

How much is owing?(Required)

Have you signed an arrears agreement with Tsawout(Required)

Yes

If yes, do you have any overdue payments in relation to that arrears repayment agreement?(Required)

Yes

Current Accommodation

Do you:(Required)

Rent

Own

Other

Untitled(Required)

What is your current payment?(Required)

Per Month / Week(Required)

Per Month

Per Week

How many bedrooms in your current house?(Required)

Please describe your living arrangment.(Required)

Extenuating Circumstances

Do any of the following circumstances apply to you:

You are currently homeless, or at imminent risk of homelessness

Your home has less than one bedroom for each adult couple

Your home has less than one bedroom for each child 16 years of age or older

Your home has less than one bedroom for every 2 children of the same sex up to 14 years of age

Your home has less than one bedroom for every 2 children of the opposite sex up to 8 years of age

A member of your household has a serious health problem or disability that is negatively affected by the current accommodations.

Please explain(Required)

Supporting Documentation of Extenuating Circumstances

Max. file size: 80 MB.

Pets

Do you or any proposed occupants have any pets?(Required)

Yes

If yes(Required)

Provide the following information for all household pets (except seeing eye dogs). You can add another pet by clicking the + icon on the right side of the form.

Type (Dog / Cat etc.)

How Many

Willing to Give Up? (Yes / No)

Breed

Consent(Required)

• This is my/our application; and
• All the information in it is correct and complete to the best of my/our knowledge.

I/We authorize:
• Tsawout to make any inquiries that are necessary to verify the information given in this application;
• Any person, corporation or social agency to release to Tsawout any information pertinent to the assessment of my/our application;
• Tsawout to receive and exchange with credit bureaus and my/our previous landlords credit and other tenancy information about me/us, to be used in the decision-making process to provide me/us with housing;
• Tsawout to collect personal banking information for the purposes of collecting rent by direct withdrawal
• The Ministry of Social Development and Social Innovation, and the Tsawout Social Development Program, to release information to the Tsawout Housing Manager regarding my/our income.

I/We understand that:
• This application is not an agreement on the part of Tsawout to provide me/us with housing;
• If I/we refuse an offer of housing, Tsawout may cancel my/our application;
• It is my/our responsibility to tell the Tsawout Housing Manager of any changes to the information given in this application and to provide any supporting materials required;
• False information given by me/us may result in my/our application being cancelled from consideration;
• 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 agree.

Signature(Required)

Today's Date(Required)

MM slash DD slash YYYY