Sipekne'katik First Nations Housing Application

Sipekne'katik First Nations

Housing Application 2025
Applicant Information:
Date Of Application*
Are you applying for:*

HouseApartmentSingle Unit
Applicant Name:*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Band Name:*
Band Number:*
Phone Number (Home):
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Work):
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Cell):
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact Number:*
Email Address:
example@example.com
Special Considerations For Housing Needs
Are you a Elder (Age 50+):*

YesNo
Are you a Senior (60+):*

YesNo
Do you require Wheelchair Accessibility:*

YesNo
Do you have any Allergies:*

YesNo
Do you have a Hearing Impairment?:*

YesNo
Do you have a Visual Impairment?:*

YesNo
If yes, please specify Mobility Needs:
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:

HouseApartmentSingle Unit
Number of bedrooms in unit:
Current Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
How long have you lived in your 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:
Starting Date:

MonthDayYear
Date
Marital Status:

MarriedSingleSeparatedDivorcedCommon-LawWidow
Spousal Information

Skip if applying single
Spouse Applicant Name:

First NameMiddle NameLast Name
Spouse Date Of Birth

MonthDayYear
Is Your Spouse / Partner A Band Member?:

YesNo
If yes please enter the information below:
Spouse Band Name:
Spouse Band Number:
Is Your Spouse Presently Employed?:

YesNo
If Yes, Where?
Does your Spouse have a visual impairment

YesNo
Does your Spouse have a hearing impairment?:

YesNo
Does Your Spouse / Partner require any special needs that aren't listed? please provide the information below:
Dependent Information
Do any of your Dependents require any special needs?:
Supporting Documents
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+
Are there any special considerations that the Sipekne'katik First Nations Housing Committee should be made aware of with this application? please provide the information below:
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:*
Date Signed:
Spouse / Partner Name:
Spouse / Partner Signature:
Date Signed:
Please Note:

Read and review the application before submitting. Incomplete applications and or false information will not be considered or accepted. Also remember to fill out a housing application for each year, repeated housing applications within the year will not grant you more "points" for a home. for example if you fill out a 2025 housing application, it will count for the year of 2025. New applications for the year will be readily available once the new year starts.
Should be Empty:

Sipekne'katik First Nations

Applicant Information:

Special Considerations For Housing Needs

Housing Information:

Employment Information

Spousal Information

Dependent Information

Supporting Documents