Ehrlo Housing Application Form

Contact Information

First name

Last name

Birth date

Phone Numbers

Please provide at least 1 of these numbers in the form 306-555-1234 or 3065551234:

Home phone

Work phone

Cell phone

Please check your housing preference:

Lakeshore Village

Chaz Court

Part A

Eligibility

Are you in Canada on a student visa or as a visitor?

Yes

To allow us to determine your income, attach all income information for each household member 19 or older, except dependants 25 or younger who are full-time students.

Provide your household's current total GROSS monthly income:

CA$

References

Current address

Are you renting?

Yes

Why are you leaving your current housing arrangement?

Previous landlords in the last five years for you and/or the co-applicant:

Other rental/character references for you and/or the co-applicant (eg. teacher, guidance counsellor, employer, support worker, etc.):

Were you referred to us by someone or by an organization?

Yes

Do you know or are you related to anyone that lives (or has lived) at any Ehrlo Housing Property?

Yes

Part B

Priority Assessment

If you meet the requirements in Part A, we will use Part B to assess your current level of need.

Describe your current living situation:

Homeless or at immediate risk of homelessness (living on the street, in a vehicle, motel, shelter or temporarily with family or friends)

Living in a home that I/we rent

Living in a home that I/we own

Other

If your current home has any hazards that make living there unsafe, please describe them here:

If anyone in your household has a permanent disability that has a housing-related impact, please describe:

If your family is separated or at risk of being separated, please explain:

Do you need to move because of stress or conflict between current household members?

Yes

If you've received a notice of eviction, please explain why:

Do you have poor access to work/services/school/childcare because of limited or no access to transportation?

Yes

Do you receive income from the Saskatchewan Income Support (SIS), Saskatchewan Assured Income for Disabilities (SAID), or Provincial Training Allowance (PTA)?

Yes

Part C

Other

Do you currently own a pet?

Yes

I understand there is a NO PET POLICY at Ehrlo Housing.

If you expect your household to increase (eg. new baby), please explain with approximate dates:

Declaration and Consent

I declare that all the facts given by me in this application are true and complete. I understand that if any fact is found to be false, my application will not be considered or, if I have been placed in a rental unit, I may be required to vacate.

I understand this application does not obligate Ehrlo Housing to provide me with an affordable housing unit.

I give my consent to Ehrlo Housing to collect, use, and disclose any of the facts given by me in Part A of this application form for any of the following reasons:

To determine if I am eligible for housing under the Affordable Housing Program.
To make inquiries to my previous landlords or respond to inquiries from future landlords regarding my tenant history.
To SHC (excluding names) for audit purposes.
To collect rent arrears or any other amount owing by me to Ranch Ehrlo Society.

I give my consent to Ehrlo Housing to collect, use and disclose of any of the facts given by me in Part B and Part C of this application for any of the following reasons:

To assess and prioritize my need for housing.
To consider my preferences for housing.

I understand that the facts given by me in this application form will be collected, used, kept, and disposed of as required by law.

By checking here, I agree to the above Declaration and Consent.