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**
Email address *
Today's Date *
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Applicant's Name *
Applicant's Phone Number *
Maiden Name
Date of Birth *
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Native Ancestry? *
Are you employed? *
If Yes, How much is your GROSS MONTHLY INCOME? *
Are you receiving any other money? Social assistance, EI, CPP, PWD, etc. If "yes" please indicate which one below and include the MONTHLY amount *
If you are on Social Assistance, please indicate your maximum shelter allowance:
Do you have dependent children? Please list their NAME, AGE and GENDER for each dependent *
Where are you currently living? ie: with family, friends, homeless, renting, etc. *
What is your current address? *
If you are renting, how much do you pay per month for rent, and why are you leaving? *
Please list your previous address(es) in the last 3 years, including Landlord's name and phone number *
Have you ever been evicted? *
If you have ever been evicted, please explain the reason as to why *
Do you have a spouse/partner? *
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