Are you homeless ? (choose Yes if you have received a notice to vacate)/
Yes  No

Do you have a physical/medical condition that is aggravated by your current living situation? 
Yes  No
If yes, explain:

Do you require or anticipate a modified/wheelchair accessible unit for a disability/
Yes No
If yes, explain:

Do you require supportive housing or life skills/
Yes  No
If yes, explain:

Are you under notice to vacate your home now? /
Yes/  No/
If yes, explain and provide notice of termination:

Due to lack of affordable housing, is your family separated?
Yes  No
If yes, explain:

Are you living with family, friends or in a motel, hotel or emergency shelter? /
Yes  No
If yes, explain:

Are you a victim of domestic violence? /
Yes  No
If yes, provide supporting documentation from physician, shelter, social worker or supporting agency.

Problem with stairs? Yes No

Problem with elevator?  Yes No

Do you have a scooter or electric power chair? Yes No

Parking Required?*  Yes No

Do you have a pet? Yes No
If yes, provide details:

Do you anticipate a change in the number of people in your household? Example: Are you expecting?
Yes  No
If yes, explain:
 

D.  Present and Previous Accommodations

Present Landlord*:

Landlord’s Phone Number*:

How long have you lived at this address?*

Your former Landlord*:

Former Landlord’s phone:

Your Former Address*:

Dates From: to:

Did you or the co-applicant ever own a home?*
Yes No
If yes, when did you stop owning it? 

Have you or the co-applicant ever lived in a co-op, non-profit, or government housing in Ontario?
Yes No

If yes, provide the following:

Name of Provider:

Provider's Phone Number: 

Rental Address: 

What Date?

Application & Verification Check List

In order to complete the application process for your housing requirements and add your name to the active waiting list, we require the following documentation (see checkmarks in red below). PLEASE NOTE YOUR APPLICATION WILL REMAIN IN PENDING STATUS, UNTIL THESE DOCUMENTS ARE PROVIDED. Lact of response to this request within 10 days will result in the CANCELLATION of your file. You can attach required documents with this application or send them later.