Brantford Native Housing - Housing Application Form

Brantford Native Housing Housing Program

Application Package
BNH Office Address

318 Colborne Street EastBrantford, ONN3S 3M9Phone: (519) 756-2205 x 227 or x 224, Fax: (519) 756-1764
BNH OFFICE USE ONLY

BNH Staff Received By: Date Reveived
APPLICATION INFORMATION

Background

Brantford Native Housing operates multiple affordable housing facilities. The many different housing facilities are geared to various Indigenous households. Our affordable housing program is offered to the following Indigenous households:
- Single clients
- Families
- Seniors
- People with disabilities
Please note, BNH’s Affordable Housing program is not Transitional housing or Emergency Shelter Housing. If you do require that model of housing, please refer to our website for more information and for the BNH Transitional Housing Application Form.

Brantford Native Housing - Affordable Housing Program

The Brantford Native Housing Program is designed to address the specific needs of Indigenous households in both urban and rural areas of Brantford and Brant County. By focusing on affordable living solutions, the program aims to provide housing that is financially accessible to Indigenous families and individuals. The program offers a range of services and supports tailored to the unique cultural and economic needs of urban Indigenous residents. This could include assistance in finding housing, looking into government subsidies to make housing more affordable, and programs that support rent assistance. Additionally, BNH’s Housing Program offers support services that go beyond housing, such as community building activities, cultural programming, and access to resources that promote one’s overall well-being.

___________________________________________

Completed Applications can be submitted to: Attn: Housing Outreach Worker

Mail or Drop Box – 318 Colborne St E, Brantford ON, N3S 3M9

Faxed – 519-756-1764 Email: roselyn@brantfordnativehousing.com and/or busime@brantfordnativehousing.com

Once we receive and review completed prospective client application forms, one of Brantford Native Housing’s staff will reach out and connect with the applicant and schedule an intake interview.

___________________________________________

HOUSING APPLICATION REQUIREMENTS

Before submitting your application, please make sure the application is complete and all required documents are attached. Incomplete applications will NOT be accepted or added to the waitlist.

Note: 50% of the household must be of indigenous ancestry to qualify. Status or status eligibility will be required.

Examples of eligible households:
- Applicant – Status
- Dependent 1 - Status
- Dependent 2 - Non-Indigenous
Examples of non-eligible households
- Applicant – Non-Status
- Co-Applicant - Non-Indigenous
- Dependent 2 - Non-Indigenous
Application Checklist
The following checklist must be completed with your application form. Applicants are required to check and provide certification proof relative to the following listed items as part of their application submission to be considered eligible for BNH’s housing program.

A. Full Application FormB. Identification included with any eligible applicant on the Application FormC. Status cards or status eligibility letter for everyone on the applicationD. Income verification for everyone collecting an incomeE. Family Composition
Accessible Forms of Identification

Drivers License, Passport, ID card, Status Card, Health Card

Acceptable Forms of Income Verification

ODSP, Income Tax Summary, OW Slip, Recent Pay Stub, Bank Statement, letter from employer with annual income, Notice of Assessment

Note: If you lack any form of ID or proof of income, please consult one of our staff members for assistance in obtaining the necessary documentation to complete your housing application. Without these documents, your application cannot be accepted.
Mandatory Documents

As part of this application the applicant(s) are required to submit the following:
1. Identification Proof
2. Co-applicant Identification Proof (if applicable)
3. Proof of Indigenous ancestry
4. Proof of Income
Please Upload all Mandatory Documents Here:

Cancelof
Housing Program Application Form

Form Begins
Incomplete Application Forms will not be Accepted
1.0 APPLICANT INFORMATION

About the Applicant
Name:

First NameLast Name
Date of Birth:

MonthDayYear
enter birthdate
Social Insurance Number
Gender
Indigenous Ancestry:
Applicant Band and Number if known:
Reminder to attach proof of Indigenous Ancestry under "Mandatory Documents" above
Current Marital Status:
Applicant Current Address:

Street Address

Unit Number

CityProvince

Postal / Zip Code
Is your Mailing Address Different than your current Address:

YesNo
If Yes, Please Include your current Mailing Address:

Street Address

Unit Number

CityProvince

Postal / Zip Code
Applicant Phone Number:
Please enter a valid phone number.
Secondary Contact Phone Number:
Please enter a valid phone number.
Applicant Email or Alternative Contact Email:
example@gmail.com
Name of Alternative Contact if used

NameRelationship
Preferred Method of Contact

CallEmailText
Emergency Contact Name

NameRelationship
Emergency Contact

Phone NumberEmail
Co-Applicant Name:

First NameLast Name
Co-Applicant Date of Birth & Social Insurance number

Date of BirthSocial Insurance Number
Co-Applicant Gender
Co-Applicant Indigenous Ancestry:
Co-Applicant Band and Number if known:
Reminder to attach proof of Indigenous Ancestry under "Mandatory Documents" above
Co-Applicant relationship to the main applicant, current address if different than the main applicant and contact information:
Please describe
Is the Applicant or Co- Applicant (if applicable) currently homeless or at risk of homelessness?

YesNo
If Yes, please provide us with more information:
2.0 FAMILY MEMBERS
Are there any other family members that will reside in the accommodations applied for? Only dependents currently under the care of the main applicant are eligible. Dependents need to live with the primary applicant, otherwise, their housing choices could be impacted.
Do all family members reside in present accommodations?

YesNo
If No, please indicate the reason for separation and their current address?
3.0 ACCOMMODATION
Which accommodation size do you require?
Is there a requirement for a modified or accessible unit?

YesNo
If Yes, please specify:
4.0 PREVIOUS LANDLORDS
Are there any other family members that will reside in the accommodations applied for? Dependents need to live with the primary applicant, otherwise, their housing choices could be impacted.
5.0 CURRENT HOUSING FINANCIAL INFORMATION
Move in Date

MonthDayYear
Date
Monthly Rent Amount ($):
Or Shared Rent Amount ($):
Utilities Total Amount ($):

Hydro Water
Other Utilities ($):
Current Number of Bedrooms?
Are you under notice to vacate your home?

YesNo
If Yes, When and Why?
Current Landlord Name:

First NameLast Name
Current Landlord Phone Number:
Please enter a valid phone number.
How much notice must you give before moving out?
6.0 TOTAL MONTHLY HOUSEHOLD FINANCIAL INFORMATION
Are there any other family members that will reside in the accommodations applied for? Dependents need to live with the primary applicant, otherwise, their housing choices could be impacted.
Please refer to Appendix A & B on the BNH website on the "How To Apply" page to learn more about valid income sources and proof of income examples for each source.
Household Total Income (Yearly):
Applicant Current Employer:
Name
Current Employer Number:
Please enter a valid phone number.
What is your position?
Current Job position
What is your hourly rate ($):
Are you working..

Full-TimePart-TimeTemporaryContract
7.0 PREVIOUS APPLICATION AND TENANCY
Has anyone on this application previously applied for rental housing in Ontario or with BNH?

YesNo
If Yes, name used on the application:
Agency Applied To:

Agency NameDate Applied
Has anyone on this application previously lived in subsidized rental housing in Ontario or with BNH?

YesNo
If Yes, name used on the application:
Address

Street Address

Unit Number

CityProvince

Postal / Zip Code
Reason for Leaving
please elaborate
Move in and Move out Date

Move In DateMove Out Date
Brantford Native Housing Consent to Obtain and Disclose Information Form

Please read and sign
I give my consent and authorization to Brantford Native Housing:
- To disclose the information given on this form to non-profit housing corporations/co-operative local housing authorities, other municipal, provincial, and federal departments and agencies that assist in the provision of affordable housing and social agencies providing social assistance to me and personas listed on this application.
- To make inquiries to verify the information given in this application and I authorize any person, corporation or any social agency having knowledge of any such required information to release the information to Brantford Native Housing.
- To disclose any information in my file to Credit Bureaus and Collection Agencies regarding arrears during and after my tenancy with Brantford Native Housing.
- To make inquiries to past landlords regarding my tenancy.
- To provide information to future landlords about my tenancy with Brantford Native Housing.
- To make inquiries to Credit Bureau and Collection Agencies regarding my financial circumstances.
- I understand that if I get housing, only the people I wrote down on this form can live with me. I, also, must report any changes in the number of people who live with me, AND any changes to my income.
- Questions about this consent and authorization should be directed to:
Brantford Native Housing – 318 Colborne St. East, Brantford, ON N3S 3M9

TEL; (519) – 756-2205 or FAX (519) – 756-1764
Applicant Signature
Date of Signing

MonthDayYear
Date
Co-Applicant Signature (if applicable)
Date of Signing

MonthDayYear
Date
Consent Form

Collection, Use and Disclosure of Personal Information
What is “Personal Information?”

Personal information includes any factual or subjective information. Recorded or not, about an identifiable individual. This includes information in any form, such as:
- Age, Name, ID Numbers, Income, Assets, Household Composition, Residency Status, Rent Payment Record, etc.
- Opinions, Evaluations, Comments, Social Status, Disciplinary Actions; and
- Employee Files, Credit Records, Loan Records, Medical Records, Existence of a Dispute between a landlord and a tenant, Intentions (I.e, to acquire goods and services, or change jobs).
Personal information does not include the name, title, business address or telephone number of an employee of an organization.

Collection and Use of Your Personal Information

Brantford Native Housing will collect, retain and use the personal information provided by you in this form and its attachments for the following purposes:
- Considering your application for tenancy;
- Verifying the information that you have provided in your application and its attachments relating to the administration and processing of your application for tenancy;
- Calculating your rent;
- For collection of your rent;
- Meeting legal and regulatory requirements arising out of or relating to your tenancy;
- For the use of Brantford Native Housing’s auditor to verify our financial records;
- For the purpose of contacting necessary services or your contact person in case of an emergency;
- For the purpose of making repairs or renovations to the housing unit;
The Housing Team of Brantford Native Housing, located at 318 Colborne St East, Brantford, Ontario N3S 3M9, (519)-756-2205 can answer questions and respond to complaints about the collection, use or disclosure of the information.

Brantford Native Housing will disclose the personal information provided by you in this form to the following parties for the purposes described above;
- To any social agency providing any form of assistance to you, or other government subsidy under the Ontario Works Act 1997, the Ontario Disability Support Program Act 1997, or any government department responsible for social housing programs under the Residential Tenancies Act, or Brantford Native Housing’s housing portfolio operating agreement;
- 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 administration or enforcing the Income Tax Act (Canada) or the Immigration Act;
- To any agent working on behalf of Brantford Native Housing for the purpose of complying with the Residential Tenancies Act;
- To any agent/contractor working on behalf of Brantford Native Housing to make repairs or improvements to the house or unit;
- To relevant agencies or contact person in case of an emergency;
- To credit bureaus and other businesses or individuals that provide credit or rental history information about you;
- To a third party in connection with the potential or actual sale, reorganization, merger, consolidation or disposition of the business of Brantford Native Housing;
- To the City of Brantford – Housing Department for any damage or rental arrears left after vacating the house or unit;
- To Financial Institutions for the collection of rent.
Consent

I authorize and agree that Brantford Native Housing may collect, use and disclose the personal information that I have provided in this form and its attachments as described above as well as disclose of personal information. I understand and acknowledge that, in addition to the foregoing, Brantford Native Housing will also collect, use, and disclose my personal information as required or permitted by law.
Applicant Signature
Date of Signing

MonthDayYear
Date
Co-Applicant Signature (if applicable)
Date of Signing

MonthDayYear
Date
To be signed by all household members living in the unit who are sixteen years or older.

*INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED*
BNH OFFICE USE ONLY

BNH Staff Received By: Date Reveived
BNH Staff Signature
Date of Signing

MonthDayYear
Date
Should be Empty:

Brantford Native Housing Housing Program

BNH Office Address

Mandatory Documents

Housing Program Application Form

1.0 APPLICANT INFORMATION

2.0 FAMILY MEMBERS

3.0 ACCOMMODATION

4.0 PREVIOUS LANDLORDS

5.0 CURRENT HOUSING FINANCIAL INFORMATION

6.0 TOTAL MONTHLY HOUSEHOLD FINANCIAL INFORMATION

7.0 PREVIOUS APPLICATION AND TENANCY

Brantford Native Housing Consent to Obtain and Disclose Information Form

Consent Form