YW Housing Society Applications

Important Information

By filling out this form, you will be added to the YW Housing Society of British Columbia housing waitlist for 388 Slocan. In selecting tenants, YW Housing Society of British Columbia will use information from one or more of the following sources:

credit checks
previous landlord reference checks
personal interviews
reviewing information available from online Court Services Online website

Applicants who are offered and accept a unit must sign a tenancy agreement and will be required to sign the relevant tenancy agreement addendums on pets, parking and smoking.

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 YW Housing Society of British Columbia will use your information to:

assess ability to uphold the obligations of a tenancy agreement
assess what size/type/location of unit within the building is most suitable

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

For all other housing inquiries, please email slocan@ywcavan.org.

Applicant Information

First Name

Middle Initial

Last name

Date of birth

Gender

Contact Information

Home address

Street address

City

Province

Postal code

Mailing address

Same as home address

Street address

City

Province

Postal code

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.

Phone

Home phone

Cell phone

Work phone

Message number

Comments

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

Household Information

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

Relative
	First name, middle name, last name Relationship to Applicant Age Gender	Item weight

more items

Residence History

Please provide information on where you have lived for the past five yeas. Use 'Add another' to add another address.

Residence
	Address (Street, City) Address (Street, City) From date From date To date Landlord name Landlord phone number Reason for leaving	Item weight

more items

Income and Asset Information

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

Income
	Name Employment Source Gross Monthly Income ($)	Item weight

more items

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?

Do you, or any member of your household, use a:

Wheelchair?

Yes

Scooter

Yes

If yes, who?

If a wheelchair is used, is it used inside your home?

Yes

Other than mobility concerns, do you or any members of your household have a health condition or disability that would require a specific type of unit?

Disability Member

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

more items

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

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

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

yes

Pets

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

Do you have any pets? (we allow one cat or one dog)

yes

Do you have an assistance dog for medical need?

yes

Pet
	Type How Many? Willing to give up? Describe	Item weight

more items

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:

YW Housing Society of British Columbia 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 YW Housing Society of British Columbia any information pertinent to the assessment of my application;
members of the YW Housing Society of British Columbia to receive and exchange information with my previous landlords to be used in the decision-making process to provide me with housing; and
YW Housing Society of British Columbia, their agents, assigns and affiliates to obtain credit/personal/employment information in relation to this application for tenancy. Further to this I give express consent and authority for my banking institution to directly release any account information as requested by the YW Housing Society of British Columbia and/or their agents accordingly. I authorize any reporting agencies, credit grantors and other persons/sources to disclose and share information on me/us currently and/or in the future with the YW Housing Society of British and/or their agents.

Yes, I understand:

that this application is not an agreement on the part of the YW Housing Society of British Columbia to provide me with housing
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 YW Housing Society of British Columbia 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 my application is kept on file for 1 year at which time I need to re-apply or contact the YW Housing Society of British Columbia.

By checking all the above boxes, you confirm that you understand and agree to the terms of the YWCA Affordable Housing application form.

Application Attachment Section

Application attachment

One file only.
2 MB limit.
Allowed types: pdf.