December 6th Program Application 2025

December 6th Program Application 2025
The December 6th Microloan Program offers no-interest bearing microloans of up to $500 for housing-related costs for women, Two-Spirit, and Gender Diverse individuals who have fled or experienced gender-based violence within the last 12 months. These housing-related expenses can include damage deposits, rent/mortgage payments, emergency relocation expenses (bus/train tickets), and Nova Scotia Power payments if an outstanding bill is a barrier to securing housing.

To access the December 6th Microloan Program you must meet the following eligibility criteria:

- Have fled or experienced gender-based violence within the last 12 months.

- Currently reside in Nova Scotia.

- Must be 18 years of age or older at time of application.

- Must have your own bank account, or be willing to open one during the application process.

Due to a high volume of applications, it can take 3-4 business days for the December 6th Team to respond to your request. We appreciate your patience.

Please Note: This program does not offer case management outside of the loan process. The December 6th team provides short-term, solution-focused support related to the loan application process for a maximum of six weeks
Referral Source*
Legal Name*

First NameLast Name
Alias/ Preferred Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Have you fled or experienced gender-based violence within the last 12 months?*

YesNo
The December 6 program is meant to assist with housing-related expenses that you are facing as a result of experiencing gender-based violence. Can you describe how this fund would help you access or maintain safe housing connected to your experience of gender-based violence? *
Safe methods of contact (Please Select all that apply)*

Phone callTextEmail
Contact Number*
Please enter a valid phone number.
Is it safe to leave a voice mail on this number?*

YesNo
Email Address*
Gender Identification*

MaleFemaleTransNon-BinaryTwo-SpiritOther
Preferred Pronouns*

She/herHe/himThey/themOther
Racial Identification*

WhiteBlackIndigenousArabicAsianEast IndianAfricanLatinoPrefer not to sayOther
Citizenship Status*

Canadian BornCanadian NaturalizedPermanent ResidentRefugeeOther
What best describes your housing situation?*

Live aloneWith roommatesWith partnerWith family or friendsShelter2nd stage housingHomelessOther
Home Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary mode of transportation*

Own carTaxiBusWalkingOther
Are you currently employed?*

Employed full-timeEmployed part-timeSelf-employedSeasonally employedUnderemployedUnemployed by choiceUnemployed b/c of disabilityUnemployedStudent
What are your current financial resouces?*

EmploymentESIACPP (OAS or disability)EIChild supportChild tax benefitPartner's incomeOther
What is your monthly income?*
What are your estimated monthly expenses?*
This may include utility payments, transportation, childcare, and basic needs such as groceries.
Do you foresee any changes in your monthly income or monthly expenses in the near future?*
This may include starting a new job, a change in work hours, or an increase in rent or mortgage payments.
What is your highest level of education completed?*

No high schoolHigh school/GEDDiplomaBachelors degreeMasters degreePh.DOther
Relationship status*

Married or common-lawRelationship (not living together)Divorced, separated, or widowedSingleOther
Do you have any no contact orders with any of your current or former partners?*

YesNo
Do you have dependent children?*

Yes, live with meYes, don't live with meYes, in temporary careYes, in permanent careChildren are adult(s)No children
Please provide an emergency contact*

First NameLast Name
Relationship to you*
Phone Number*
Please enter a valid phone number.
What are you hoping to use the December 6th Microloan for?*

Damage depositRent/mortgage paymentNova scotia power paymentEmergency relocation expenses
Do you have your own bank account?*

YesNo
Other supports needed (please check a maximum of three)*

HousingService navigationEducationParenting supportExiting traffickingChildcareHealthcareGender-affirming healthcareSubstance use supports (harm reduction or recovery)Mental health supportsFood supportSafety planningOther
Your confidentiality is important to us. If you require additional services within, or beyond the scope of the December 6th Program and would like YWCA Halifax to contact other programs and services on your behalf, please sign this consent form. We will consult with you on what information can and cannot be shared before communication of personal information to any service provider. You may revoke consent at any time. Disclosure of data and personal information will be limited to individual consent gained or in the case of subpoena or legally required disclosure such as the Duty to Report.
I, (print your name)*
Name
Authorize December 6th Program Staff, to disclose my information pertaining to my case file for the purposes of case management and service provision to the following agencies and individuals:

Other YWCA staff/programsMy landlordUtility companyChild/ family servicesIncome assistanceLawyers/ legal aidParole/probation officerOther non-for-profit agencyOther
Please provide the contact information (Program Name/Contact Person Name, Email Address & Phone Number) for options check-marked above.
YWCA Halifax will be entering your data into a secure database and may use anonymous and de-personalized data collected on this form for the purposes of research. program planning, policy development and/or organizational strategic planning. This means you will not be identifiable and your comments will be kept confidential. This information is sometimes required by funders to evaluate the effectiveness of the program, and will assist us in serving you, and all of our participants better. YWCA Halifax will collect and store electronic data on for the purposes of:

a. Case management
b. Program coordination and development
c. Statistical reporting
d. Research
e. Program evaluations
f. Funder compliance
g. Fund development
h. Partnership development
i. Payroll
j. Emergency contact
k. Human resources

No data or personal information will be collected or stored which falls outside any of these stated purposes. YWCA Halifax will limitthe use of data and personal information to the purposes stated above. YWCA Halifax will retain data and personal information for no longer than 7 years.
Signature*

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Witness signature (if under 18 years old)

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