Waitlist Request Form
Thank you for your interest in the Independant Rental Units located at 3311 Menno Street in Vineland Ontario. Please be advised these apartments are for seniors ages 65+ who have the ability to live independently. Please reach out to Ashley Scholman at ascholman@umh.ca with further questions.
Name
*
Full Name
Last name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Name
Full Name
Last name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Email Address
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status
Single
Married
Divorced
Widow/er
Church Affiliation
Back
Next
Apartment Type
Please select all that apply
I want to be considered for a...
*
1 Bedroom Apartment
2 Bedroom Apartment
Are you applying for the 1 bedroom affordable units?
Yes
No
I would prefer my apartment to be on the...
*
Ground Floor
Second Floor
Third Floor
I would prefer my apartments to face
*
Twenty Third Street
Menno Street
The Parking Lot
No Preference
Prefered date of occupancy
As soon as possible
1 - 5 years
5 - 10 years
10 - 15 years
Other
Additional Questions or Concerns
Back
Next
Emergency Contact
Children or Next of Kin
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Relation
*
Ex. Daughter
Back
Next
Signature
*
Signature
Apply
Apply
Should be Empty: