Programs & Services

Predetermined Rent Housing Application

Important Information

**Before completing this form, make sure you have read the Housing Eligibility and Criteria .

By filling out this form, you will be added to the YWCA housing waitlist for the Predetermined Rent housing site(s) you have selected below. The YWCA’s waitlist is used to review applications as units become available. The YWCA will gather updated information on all household members, including income and assets, and may complete additional checks to assess a household’s ability to uphold the obligations of a tenancy agreement. This may include reference checks, personal interviews and/or reviewing information available from public sources such as Court Services Online and police websites. Applicants may be contacted for more information.

Applicants who are offered and accept a unit must sign a tenancy agreement and may be required to sign tenancy agreement addendums that cover topics such as pets, parking, laundry, smoking, crime free housing, etc.

Purpose of this Form

This form collects personal information in accordance with section 26(c) of the Freedom of Information and Protection of Privacy Act. Your personal information is collected for the following purposes, and the YWCA Metro Vancouver will use your information to:

determine eligibility; and
assess housing need

If you have questions about your privacy, send questions in writing to Lisa Rupert, Vice President, Housing Services & Violence Prevention: lrupert@ywcavan.org

I am applying for housing at (check all that apply):

Pacific Spirit Terrace, Vancouver

xʷƛ̓əpicən, Arbutus Ridge, Vancouver

Como Lake Mews, Coquitlam

May Brown Place (previously St. Georges), North Vancouver

Moiz and Nadia Place, Richmond

Applicant Information

First Name

Middle Initial

Last Name

Date of Birth

Age

Contact Information

Home Address

Street Address

City

Province

Postal Code

Mailing Address

Same as home address

Street Address

City

Province

Postal Code

Email (please provide applicant's personal email address)

A confirmation email will be sent to this address once you have submitted your application form. Please ensure that you submit your personal email address and check your junk/ spam folders if you don’t see it in your inbox.

Home Phone

Cell Phone

Work Phone

Message Number

Comments

Best way and time to reach you? (if anytime, leave blank)

Household Information

a. List all other household members. Use “Add another” to add another household member.

Relative
First Name & Initial Last Name Relationship to Applicant Date of Birth Age Sex

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

Yes

If No, please provide the following information for all persons not living with you full time.

Part-time Household Member
Name # days per week Shared Custody? Yes No If not shared custody, why are they not living with you full time?

D. Number of Children in Household

e. 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.

f. (optional) Do you or anyone in your household identify as being an Aboriginal person of Canada?

Yes

Note: Question 3F is optional and does not impact eligibility for housing. We do, however, give additional consideration to applicants who have identified as being an Aboriginal person of Canada.

Residency History

a. Please provide information on where you have lived for the past five years. Use "Add another" to add another address.

Residence
Address (Street, City) From Date To Date Landlord Name Landlord Phone # Reason for leaving

Income and Asset Information

a. Please list all income sources, list gross monthly income (before deductions, do not include child tax) for all household members age 19 and older.

Income
Name Income Source Gross Monthly Income ($) If you have indicated OTHER as a source of income, please indicate the source:

Total GROSS Monthly Income for Household

b. For any adult (age 19 or older) with no income, please tell us why there is no income. If you are declaring student status, please note that we will require documented proof of student status.

c. List the current value of all assets held by you and members of the household. Please include shared assets and/or assets you may not currently have access to

Cash/Bank Balance

RRSPs/Annuities

Residential Real Estate

Stocks/Bonds/Term/Deposits

Other Assets (describe)

Other Real Estate Holdings

Health and Mobility Information

a. Do you, or any members of your household, have restrictions with stairs?

No restrictions

Cannot manage stairs

Limited number of stairs

How many?

c. Other than mobility concerns, do you or any members of your household have a health condition or disability? (Eg. Autism Spectrum Disorder, FASD, ADHD, PTSD)

Disability Member
Name of household member Explain the health condition or disability

d. Please describe any special requirements or features you may need in your housing related to your mobility or health condition?

To assist with matching you to housing that best suits your needs, please complete the following questions. The YWCA may give special consideration to people who have health and mobility issues.

Housing Preferences/Choices

a. Would you live in a ground floor unit?

Yes

b. Are you willing to sign a non-smoking agreement?

Yes

c. Would you consider housing without parking? (If you are offered a parking space, we will require proof of insurance.)

Yes

d. Do you have any pets?

Yes

Do you have an assistance dog for medical need?

Yes

Provide the following information for all household pets (do not include assistance dogs)

Pet
Type How Many? Willing to give up? Describe

e. Would you live in a wood-frame building? Most of our buildings are wood frame.

Yes

f. Are you willing to live in a building where you cannot have a guest stay with you for more than 14 overnights in the calendar year?

Yes

g. Are you willing to live in a building where you cannot have any current or future intimate partner live with you, or any family members that are not currently living with you?

Yes

h. Are you willing to purchase and maintain the required tenant insurance for the length of your tenancy?

Yes

i. Are you connected with any YWCA program?

Yes

If Yes, which one(s)?

Answers to the questions below will help the YWCA match you to suitable units.

Application Attachment

If you wish to upload a reference letter, Rent it Right, or RentSmart certificate please attach PDF here. Please note that reference letters and certificates are not required. (PDF format only)
One file only.
2 MB limit.
Allowed types: pdf.

Application Form Declaration

Yes, I declare:

this is my application; and
all the information in it is correct and complete to the best of my knowledge.

I authorize:

YWCA Metro Vancouver to make any inquiries that are necessary to verify the information given in this application;
any person, corporation or social agency to release to the YWCA any information pertinent to the assessment of my application;
members of the YWCA to receive and exchange information with my previous landlords to be used in the decision-making process to provide me with housing; and
Ministry of Social Development and Social Innovation to release information to the YWCA regarding my income.

Yes, I understand:

that this application is not an agreement on the part of YWCA to provide me with housing;
that if I refuse one offer of housing, my application will be cancelled;
that if I am being considered for an available unit, housing providers will gather additional information in order to assess my ability to uphold the obligations of a tenancy agreement and it is my responsibility to provide or cause to be provided information requested to assist with this assessment;
that it is my responsibility to tell the YWCA of any changes to the information given in this application and to provide any supporting materials required;
that false information given by me may result in my application being cancelled from consideration; and
that if I have deliberately worsened my current housing situation (e.g., terminated a tenancy for no reason)that my application may not be accepted or my current living situation may not be taken into consideration;
that my application is kept on file for 1 year at which time I need to re-apply or contact the YWCA;
that I am advised to review the YWCA Housing Eligibility and Criteria and the YWCA Housing’s Frequently Asked Questions and I do understand that the YWCA is not able to consider me for housing if I do not meet the eligibility requirements as outlined under therein.

Fill out this checklist. This will confirm that you understand and agree to the terms of the YWCA Affordable Housing application form:

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