Application Form for Lion's Place - Affordable Housing Complex

First Name*

Last Name*

List any other names you may be known by

Date of Birth*

Cell Phone*

Other Phone

Accommodation required and Preferences

Number of bedrooms required*

1 Bedroom

Bachelor Unit

Do you require a wheelchair accessible suite?*

Yes

Do you require parking?*

Yes

Do you have any special living requirements? If yes, please summarize

Household Information

Please list yourself on the first line and then all those who will live with you.

Full Name

Date of Birth (YYYY/MM/DD)

Pronouns (She/He/They)

Relationship to Applicant

Residency History

Please list your addresses for the past 4 years.

Address

From (YYYY/MM/DD)

To (YYYY/MM/DD)

Landlords Name and Number

Current Accomodation

Are you currently renting?*

Yes

If you are renting, how much is your monthly payment? $

How many bedrooms?

What kind of rental is it?*

House

Apartment

Shared Space, Private Room

Other

If Other, please specify

Government issued ID*

Max. file size: 50 MB.

Applicant Checklist

Complete application

Copy of government issued ID

How did you hear about Lion's Place?

Check the box(s) that best reflect your current circumstances

Are you at risk of violence or abuse?*

Yes

Are you currently staying at Transition Housing?*

Yes

Have you experienced any form of violence or abuse?*

Yes

Are you at risk of homelessness?*

Yes

Are you an adult with a diverse ability?*

Yes

Do you currently receive support from CLBC?*

Yes

Are you currently working with any mental health teams?*

Yes

If yes, please specify which support you are accessing

Do you currently access support services at Rose / Eagle Harbour?*

Yes

Are you currently receiving drug and alcohol treatment?*

Yes

Are you a smoker?*

Yes

Please describe your current housing circumstances: Briefly describe your reason for applying.*

Are you expecting any changes to your household composition in the next year?*

Yes

If yes, please explain

Acknowledgement

I/We certify that the information on this form is true, correct, and complete in every respect to the best of my/our knowledge and can be verified by Rivercity Inclusion including obtaining credit and/or personal reports on me/us from one or more agencies or individuals. I/We hereby authorize agencies or individuals, such as CLBC, to provide information to Rivercity Inclusion Society as it is relative to assessment of the application. I/We understand this application does not constitute an agreement on the part of Rivercity Inclusion Society to provide me/us with rental housing.

I/We Agree

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