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Affordable Housing Solutions Corporation
Application

Application Form for: 

  • 82 Munroe Street - Cobourg

  • 86 Munroe Street - Cobourg

  • 173 Strang Court - Goderich

Instructions: 

  1. Please complete ALL sections of this form.

  2. Read and Sign the Consent form and the Declaration at the bottom of the form.

INCOMPLETE APPLICATIONS WILL NOT BE PLACED ON THE WAITLIST

When it is close to the time of offer, You must 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

Status in Canada
Canadian Citizen
Permanent Resident
Sponsored Immigrant
Refugee/Refugee Claimant
Other
Gender
Male
Female
Other
Date of Birth
What is your preferred method of contact?
Home Phone
Cell Phone
Email
Can we safely contact you at this address and/or number?
Yes
No

Alternate Contact Information

Did someone assist with this application?
Yes
No
May we contact them?
Yes
No
Permission to send mail or discuss your application?
Yes
No

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Did you move out owning arrears?
Yes
No

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Household Information

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

Person 1 

Date of Birth

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Person 2

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Person 3

Date of Birth

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Person 4

Date of Birth

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Do all the people currently live with you?
Yes
No
Were all the people in your household born in Canada?
Yes
No

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Present Accommodation

Current living situation
Own
Rent

Current Landlord Information

Please leave blank if you own your own home.

Length of Tenancy

Move-In Date
Move-Out Date

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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:

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Full-time work

Part-time work

Casual or seasonal work

Odd jobs

Seasonal/vacation pay

Long-term/Short tern disability

Yearly bonus

Shift bonus

Cost of living bonus

Sickness pay

Tips of gratuities

Overtime pay

Commissions

Self-employment

Tutoring

Child Care

Business income

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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

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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)

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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
No

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

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Building Selection Sheet

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

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

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Release & Consent

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

  1. 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.

  2. I understand that the (AHSC) will use the information I give them to see if I qualify for the housing I have applied for.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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."

Today's Date

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Declaration

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

  1.  I give my word that everything I have written in this application is correct and complete.

  2. 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.

  3.  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.

  4. I understand that only the people I have listed on this application form may live with me.

  5.  I understand that (AHSC) will use the information I give them to see if I qualify for the housing I have applied for.

  6. I give my word that I am in Canada legally.

Today's Date
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