Affordable Housing Rental Application

Applicant's Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Do you have rent assistance?*

YesNo

If yes, who helps pay your rent?

What is your current living situation?*

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have lived at your current address?*

Reason(s) for leaving for your current address?*

Current Landlord Name*

First NameLast Name

Current Landlord Phone Number*

Please enter a valid phone number.

List the total number of people who will occupy the property (including yourself)*

Please list the names and information of everyone who will live with you in the unit. If you plan to live with a roommate, write "Roommate" in Relationship. You only need to submit one application for the two of you.

Do you expect the number of people in your family to change in the next 12 months?*

YesNo

If yes, please explain

Eligibility for tenancy is based on the income of all household members over the age of 19. Please submit a Declaration of Income with this application. Include all supporting documents.

Attach your Declaration of Income and any other supplementary documents here.

Do you have a Vehicle?*

YesNo

Vehicle Information

	Year	Model	Make	License Plate #
1
2
3
4

Do you have a current SPARC pass?*

YesNo

Do you have pets?*

YesNo

Is your pet a service animal?

YesNo

If yes, please upload documents

Please include all of your pets below

I am willing to find a new home for my pet

YesNo

Do you have physical accessibility needs?*

YesNo

If yes, please fill out the accessibility needs form

Are you eligible for Community Living B.C. (CLBC) funding?*

YesNo

If yes, please include a letter from CLBC confirming your eligibility

Please list all previous housing from the last two years. If you have not previously rented, please include two references.

Name of Reference #1

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Relationship to you

Name of Reference #2

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Relationship to you

Name

First NameLast Name

Organization

Phone Number

Please enter a valid phone number.

Email

example@example.com

Click each box below to acknowledge you have read and agree to each statement.

I hereby authorize agencies or individuals listed above to provide information they to Inclusion Homes relative to the assessment of the application for tenancy. Pursuant to the Freedom of Information and Protection of Privacy Act, Inclusion Homes can make any inquiries necessary to verify information given in this application for affordable housing.I certify that the information on this form is true, correct and complete in every respect to the best of my/our knowledge and can be verified by Inclusion Homes including obtaining personal reports on me from one or more agencies or individuals. I give permission for Inclusion Homes to run a credit check at their discretion in order to determine my suitability for tenancy.I understand this application does not constitute an agreement on the part of Inclusion Homes to provide me with rental accommodation.It is my responsibility to advise Inclusion Homes of any changes to the information given in this application and to provide relevant supporting materials required or requested, as well as submitting an application update form on a yearly basis. I understand that failure to do so may compromise my eligibility.

Name*

First NameLast Name

Applicant's Signature*

Date Signed*

MonthDayYear

Please verify that you are human*

Tipton Place Rental Application

Current Housing Information

Occupants of the Unit

Income Information

Vehicles

Pets

Accessibility

Housing History

References

Support Worker