Sipekne'katik First Nations Housing Application

Sipekne'katik First Nations

Housing Application 2025
Date Of Application*
Are You Applying For:*

HouseApartmentSingle Unit
Application Information:
Applicant Name:*

First NameMiddle NameLast Name
Date Of Birth*

MonthDayYear
Band Name:*
Band Number:*
Phone Number (Home):
Please enter a valid phone number.
Phone Number (Work):
Please enter a valid phone number.
Phone Number (Cell):
Please enter a valid phone number.
Primary Contact Number:*
Email Address:
example@example.com
Are You An Elder (Age 50+):*

YesNo
Are You An Senior (60+):*

YesNo
Do You Require Wheelchair Accessibility:*

YesNo
If Yes, Please Specify Mobility Needs:
Do You Have Any Allergies:*

YesNo
If Yes, Please Specify:
Housing Information:
Do You Presently Own A House?:*

YesNo
If Yes, Is It:

On-ReserveOff-Reserve
Do You Rent Or Board Accommodations?:*

YesNo
Type Of Unit:

HouseApartment
Number Of Bedrooms In Unit:
Current Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
How Long Have You Lived In Current Address?:
Years*
Months*
Employment Information
Are You Presently Employed?:*

YesNo
If Yes, Where?
If No, What Is Your Present Means Of Financial Support?
Social Assistance:

YesNo
Disability Assistance:

YesNo
Pension:

YesNo
Employment Insurance:

YesNo
Other:
Is Your Spouse Presently Employed?:*

YesNo
If Yes, Where?
Starting Date:

MonthDayYear
Date
Do You Have A Visual Impairment?:*

YesNo
Do You Have A Hearing Impairment?:*

YesNo
Marital Status:

MarriedSingleSeparatedDivorcedCommon-LawWidow
Spousal Information
Applicant Name:*

First NameMiddle NameLast Name
Date Of Birth*

MonthDayYear
Is Your Spouse / Partner A Band Member?:*

YesNo
If Yes Please Specify:
Band Name:*
Band Number:*
Do You Have A Visual Impairment?:*

YesNo
Do You Have A Hearing Impairment?:*

YesNo
Does Your Spouse / Partner Require Any Special Needs?:
Dependent Information
Do Any Of Your Dependents Require Any Special Needs?:
Are There Any Special Considerations That The Sipekne'katik First Nations Housing Committee should be made aware of with this application?:
Supporting Documents
Do You Have A Visual Impairment?:*

YesNo
The Sipekne'katik First Nations Housing Committee May Require Any Or All Of The Following Documents To Be Submitted:
Marriage Certificate:*

YesNo
Divorce Decree:*

YesNo
Custody Order:*

YesNo
Adoption Certificate:*

YesNo
Medical Notes For Disabilities:*

YesNo
Building Inspection Certificate:*

YesNo
Fire Inspection Certificate:*

YesNo
Health Inspection Certificate:*

YesNo
Have You Applied Before?:*

YesNo
If Yes, How Many Times?:

First Time2-56-1010+
Supporting Documents Upload:

Cancelof
The Sipekne'katik First Nations Housing Committee does not and shall not discriminate the applicant on the basis of race, colour, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, employment status, social status, or military status, in the application process.

I / We declare that all information in this application to be accurate and up-to-date. I do realize that any false or misleading information may jeopardize the success of my application and may hinder the application process. False or misleading information may result in the rejection of the application, whereas I / We will have to restart the application process.
Applicant Name:*
Applicant Signature:*

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Date Signed:
Spouse / Partner Name:
Spouse / Partner Signature:

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Date Signed:
Please Note:

Read and review the application before submitting. Incomplete applications and or false information will not be considered or accepted.
Should be Empty:

Sipekne'katik First Nations

Application Information:

Housing Information:

Employment Information

Spousal Information

Dependent Information

Supporting Documents