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Aqanttanam Housing Society - Affordable Housing Application
**Please provide as much information as possible, and fill out the questions completely. A lack of information will result in a longer processing time**
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Email
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Your email
Today's Date
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MM
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DD
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YYYY
Applicant's Name
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Your answer
Applicant's Phone Number
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Your answer
Maiden Name
Your answer
Date of Birth
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MM
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DD
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YYYY
Native Ancestry?
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Your answer
Are you employed?
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Yes
No
If Yes, How much is your GROSS MONTHLY INCOME?
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Your answer
Are you receiving any other money? Social assistance, EI, CPP, PWD, etc. If "yes" please indicate which one below and include the MONTHLY amount
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Your answer
If you are on Social Assistance, please indicate your maximum shelter allowance:
Your answer
Do you have dependent children? Please list their NAME, AGE and GENDER for each dependent
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Your answer
Where are you currently living? ie: with family, friends, homeless, renting, etc.
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Your answer
What is your current address?
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Your answer
If you are renting, how much do you pay per month for rent, and why are you leaving?
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Your answer
Please list your previous address(es) in the last 3 years, including Landlord's name and phone number
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Your answer
Have you ever been evicted?
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Yes
No
If you have ever been evicted, please explain the reason as to why
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Your answer
Do you have a spouse/partner?
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Yes
No
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