Application for Subsidized Housing in Ottawa

1 Application for Subsidized For Office Use Only Housing in Ottawa Date: Rec. by: The Application must be completed in full and returned to: The Registry 2197 Riverside Dr., 5th Floor Ottawa , Ontario K1H 1A9 Phone: 613-526-2088. Version fran aise disponible. We do not accept applications by fax. 1. Eligibility Rules To be eligible for Subsidized Housing , you must meet all of the following conditions: All members of the household must be a Canadian citizen, Landed Immigrant, Refugee or Refugee Claimant. No member of the household is currently under a deportation, departure or exclusion order to leave Canada. At least 1 person in your household must be 16 years of age and older.

2 No member of the household owes money to any social Housing provider. No member of the household has been convicted of an offence in relation to rent-geared-to-income assistance or found by a court of law or the Landlord and Tenant Board to have misrepresented their income for the purpose of rent-geared-to-income assistance. If you own a house or rent any other property, you must agree to sell it or terminate the lease within 180. days of being housed. You must be able to live independently, and make your own arrangements for support services. 2. Additional Information You must report any changes to this information directly to The Registry. You must update your Application at least once per year with The Registry.

3 Failing to provide updated information will result in the cancellation of your file. The system for selecting households is based on the date of your Application . Special Priority may be given to your Application if you are being abused by someone whom you live with, lived with, or is acting as your sponsor. Certain criteria must be met. Urgent status may be given to your Application if you have a life-threatening or terminal illness made worse by your current living situation or your personal safety is threatened. You may be given special status if you are homeless. You may be required to pursue income from one or more of the following sources: Ontario Works Support payments Employment Insurance Any pension or support payments required under a sponsorship agreement Failure to pursue a specific type of income within the required time frame will result in a decision of ineligibility at the time of a Housing offer.

4 You are only entitled to 3 offers of Housing . If all offers are refused the file will be cancelled. When you accept an offer of Housing from any one of the Housing providers you have applied to, you will no longer be on the waiting list for any other Housing provider. If you want to move to another Housing provider later on, you will then have to re-apply. The information you give us on this form and your attached documents will be used to determine your eligibility for Subsidized Housing . Some Housing providers may need more information. 11/03/2014 1. 3. Instructions Please fill out all sections of the form. Please print, in ink. You must provide proof of Canadian residency for all household members ( birth certificate, immigration documents, etc.)

5 You may be requested to provide documents to verify any information you have included in your Application . Read the Release and Consent and Declaration . All household members 16 years of age and older must sign the form. All household members must report and provide proof of their current income. 4. Household Information Please provide information about yourself and all other adults and children who will live in the Housing you are applying for. All household members listed must be available to move in at the time of offer. This section must be filled out. All household members must report and provide proof of their current income. Gross Income Source Last Name First Name Date of Birth Sex Relationship Monthly (work, pension, D/M/Y M/F to applicant Income assistance, etc.)

6 Proof required / / Applicant / /. / /. / /. / /. / /. / /. / /. Is a baby expected? Yes No If Yes, date expected: Present Address Street No. Street Name Apartment No. City / Province Postal Code Social Insurance No. (Optional) Home Telephone Work/ Daytime Telephone *. ( ) ( ). Present Landlord Landlord Telephone Monthly Rent Is this a social Housing provider? Yes No If Yes, reason for move: How long have you lived at the above address? Number of bedrooms in current unit: If you have lived at the above address for less than two years, provide previous address: Are you currently sponsoring or in the Application process to sponsor anyone in Canada?

7 Yes No Have you ever lived with a social Housing provider? Yes No If yes, which one? When did you vacate? Have you ever been evicted for cause from a social Housing provider? Yes No Are you receiving any other Housing benefit (rent supplement, Housing allowance, etc.)? Yes No If Yes, which benefit? Other person to contact Do you need an interpreter? Yes No Name: If Yes, person to contact: Telephone: Telephone: Spoken language(s) English French Preferred language for correspondence English French * Calls to offer Housing are usually made during office hours. Please ensure that you can be reached during the day. 11/03/2014 2. Please check any of the following that apply to you (optional): I am currently a victim of domestic abuse and want to be considered for special priority.

8 You must provide supporting documents from a professional (contact The Registry for a list of qualifying professionals).You will be required to have an interview with a staff member of The Registry. Please provide a SAFE mailing address (if different from your present address reported on pg, 2) and a telephone number where you can be contacted: same as address and telephone number given above; OR: Street Name and Number _____ Apt. Number _____. City _____ Province _____ Postal Code _____. Telephone Number _____ Contact person _____. List any areas you cannot live in due to safety concerns _____. _____. Please call The Registry if you cannot be reached by telephone.

9 Homeless (you may be asked to provide supporting documents). Are you staying at an emergency shelter? Yes No If yes, which one: _____. Are you staying on the street (includes car, make-shift shelter) Yes No Please explain your situation: _____. Last permanent address: _____. _____. 5. Housing Preferences Please check your preferences. You may check more than one. (a) I want to live in: a Senior Citizen community a mixed community (families, singles, seniors). (b) I would consider: an apartment a townhouse The size of the unit you qualify for will depend on the size and special needs of your household. (a) As a single person, you qualify for a 1 bedroom apartment.

10 Would you also consider: a bachelor apartment? Yes No or a room (in a rooming house)? Yes No (b) There is a shortage of larger units, and larger households may be given priority for them. Are you willing to have any of your children share a bedroom? Yes No Do you require parking? Yes No Do you or any member of your household have special Housing needs due to serious health reasons or disabilities? Yes No Who? Supporting medical documents will be required for any request regarding special Housing needs. Wheelchair Modified Unit Wheelchair Accessible Building No carpeting Other 11/03/2014 3. The community has been designated as Smoke-Free. Please note that some communities may have specific internal policies ( pet policies, tenant insurance, satellite dishes, etc.)