Online Rental Application | Affordable Housing

Affordable Housing Solutions Corporation
Application

Instructions:

Please complete ALL sections of this form.
Read and Sign the Consent form on page 7 and the Declaration on page 8.

INCOMPLETE APPLICATIONS WILL NOT BE PLACED ON THE WAITLIST

When it is close to the time of offer: You will be required to provide a Birth Certificate or Status in Canada for all household members, Income Verification, Financial information, Asset documentation, Proof of Custody for all dependents, and any other information required to verify eligibility.

Primary Applicant

First Name

Middle Name

Last Name

Gender

Male

Female

Other

Date of Birth

Social Insurance Number

Street Address

Home Phone Number

Cell Phone Number

What is your preferred method of contact?

Home Phone

Cell Phone

Can we safely contact you at this address and/or number?

Yes

If no, where can we contact you:

Alternate Contact Information

Did someone assist with this application?

Yes

Name

Phone

Agency or Relationship

May we contact them?

Yes

Permission to send mail or discuss your application?

Yes

Previous Address

Name of Housing Provider

Did you move out owning arrears?

Yes

Household Information

Please provide information about all adults who will live with you.

Person 1

First Name

Date of Birth

Last Name

Male / Female

Relationship

Social Insurance Number

Person 2

First Name

Date of Birth

Last Name

Male / Female

Relationship

Social Insurance Number

Person 3

First Name

Date of Birth

Last Name

Male / Female

Relationship

Social Insurance Number

Person 4

First Name

Date of Birth

Last Name

Relationship

Male / Female

Social Insurance Number

Do all the people currently live with you?

Yes

If no, please explain:

Were all the people in your household born in Canada?

Yes

If no, please explain:

Present Accommodation

Current living situation

Own

Rent

Current Landlord Information

Please leave blank if you own your own home.

Landlord Name

Landlord Address

Landlord Phone Number

Length of Tenancy:

From:

To:

Income Information

At the time of application, self-declaration of MONTHLY income BEFORE deductions is required.

When an offer of housing is made to you, proof of your gross income and assets will be required.

List all income you and the members of your household receive from all sources. This can include but is not limited to income sources such as:

Employment:

Full-time work
Part-time work
Casual or seasonal work
Odd jobs
Seasonal/vacation pay
Long-term/Short term disability

Yearly bonus
Shift bonus
Cost of living bonus

Sickness pay
Tips or gratuities

Overtime pay

Commissions

Self-employment:

Tutoring
Child care

Business income

Pensions, Allowances and Other Income:

Ontario works

ODSP
CPP (all benefits)

OAS/GIS

GAINS

RIF payments

Employment Insurance
Company pensions
Workers compensation payments Alimony payments
Child support payments
Canada Child Benefit

Annuities

One-time lump sum payments (inheritances, court settlements)

OSAP/ Grants/Bursaries

Investment income

List the following

1. Name of person receiving income

2. Type of income/asset income (refer to examples above)

3. Gross monthly income (before deductions)

Total Monthly Income

Unit Size

What size unit do you want to apply for?

1 Bedroom

2 Bedroom

Modified Units

Do you require a modified unit (e.g. wheelchair access unit)?

Yes

If yes, you will need to obtain the Limitations Assessment Form, to be completed by your health care professional.

Building Selection Sheet

Check the box below to be considered for the Affordable Housing Buildings in Cobourg or Goderich, Ontario.

Cobourg, Ontario

82 Munroe Street, Cobourg, Ontario - Market - 1 or 2 Bedroom Apartment - Elevator/Non-Smoking

86 Munroe Street, Cobourg, Ontario - Senior - 1 Bedroom Apartment - Elevator/Non-Smoking

Goderich, Ontario

173 Strang Court, Goderich, Ontario - Market & Affordable - 1 & 2 Bedroom Apartment - Elevator/Non-Smoking

Release & Consent

Please read this carefully, and sign in the spaces below.

I understand that Affordable Housing Solution Corp. (AHSC) as service manager and any Housing Provider listed in my application are permitted under the Housing Services Act, 2011 (the “Act”) to collect personal information about me so long as they comply with the standards for collecting, using, disclosing and safeguarding information as set out in the Act.
I understand that the (AHSC) will use the information I give them to see if I qualify for the housing I have applied for.
I allow (AHSC) to give the information on this form and any attachments to the social services offices, other municipal service managers or district social services administration boards, housing providers, without further notice to me, if the information is necessary for the purpose of making decisions or verifying eligibility for assistance under the Housing Services Act, 2011, the Ontario Works Act, 1997, the Ontario Disability Support Program Act, 1997, or the Day Nurseries Act.
I allow (AHSC) to give the information on this form and any attachments to the government of Canada, a department, ministry, or agency of it, without further notice to me if the information is necessary for the purpose of administering or enforcing the Income Tax Act (Canada) or the Immigration Act.
I allow (AHSC) to give the information on this form and any attachments to any government or body with whom (AHSC) has made an agreement under the Housing Services Act, 2011, without further notice to me, for the purpose of conducting research related to a social benefit program.
I understand that any information on this form and any attachment given by (AHSC) to a body listed above is confidential and will only be given in accordance with the Housing Services Act, 2011 and associated regulations.
I consent to the collection of information by, and the release of information to an authorized representative of (AHSC) for the purposes of responding to my request for further information and assistance.

If you have any questions about the collection and use of personal information, please contact: (AHSC), 403-1670 Bayview Ave., Toronto, ON M4G 3C2. 1-800-667-5756

“Personal information contained in this form or in attachments is collected by AHSC, 2512464 Ontario Inc, and 82 Munroe Inc pursuant to the Freedom of Information and Protection of Privacy Act (R.S.O. 1990 c.F31.) or the Municipal Freedom of Information and Protection of Privacy Act (R.S.O. 1990 c.M.56). This information may be used to determine eligibility for housing."

Applicant Signature

Co-Applicant Signature

Today's Date

Declaration

Please read this carefully, and sign in the spaces below.

I give my word that everything I have written in this application is correct and complete.
I understand that all information I give to (AHSC) will belong to them and they will give my information to the housing providers I have chosen.
If something on this application is incorrect or not true, (AHSC) or the housing providers I have applied to may request additional information, may cancel my application or both, and I may be prohibited from re-applying for assistance for a minimum period of four years under the Housing Services Act, 2011.
I understand that only the people I have listed on this application form may live with me.
I understand that (AHSC) will use the information I give them to see if I qualify for the housing I have applied for.
I give my word that I am in Canada legally.

Applicant Signature

Co-Applicant Signature

Today's Date

Questions about this collection should be directed to:

(AHSC)403-1670 Bayview Ave. Toronto, Ontario M4G 3C2
Phone: 416-486-5447
Toll-Free: 1-800-667-5756
Fax: 416-486-7122
Email: jtozak@affordablehousingsolutions.ca

Proof of ALL Income, Assets and Investments, Status in Canada, Custody Documentation, and all other information necessary to verify subsidy eligibility will be required

It is your responsibility to notify our office of any changes in your circumstances within 30 days. If we are unable to contact you, your name will be removed from the waiting list, and your file will be cancelled.

The document is available in an alternate format upon request. To request an alternate format, call 416-485-5447.

Thanks for submitting your application!

Affordable Housing Solutions Corporation Application

Primary Applicant

Alternate Contact Information

Household Information

Present Accommodation

Current Landlord Information

Income Information

List the following

Unit Size

Modified Units

Building Selection Sheet

Release & Consent

Declaration

Affordable Housing Solutions Corporation
Application