Evergreens Social Housing Application

Social Housing Application
(Confidential)

Revised September 2025
This application CANNOT be processed unless ALL questions are fully answered.

Complete ALL questions supplying ALL of the requested information. If a question does not apply to your situation, mark N/A in the section. Please provide us with the following:
- Social Assistance, a letter from the appropriate official must be attached verifying the amount of the benefit. (Social Assistance Verification Form – Page 8)
- A copy of your Income Tax Assessment showing Line 15000 for the immediate preceding taxation year for each member of your family age 22 years and older.
- Copies of all applicants’ Personal Health Care Cards.
Residency Requirement: Applicants must have lived within The Evergreens Foundation‘s boundaries for 6 months prior to application.

If a translator was required to compete this application, provide their name and telephone number:
Translator’s Name
Telephone Number
Rental Assistance Inquiries Vivian Williams Ph: 780-225-2664 Email: ahm@theegf.com

The personal information collected through The Evergreens Foundation is for the purpose of subsidized housing or rental benefits. This collection is authorized by section 33(c) of the Freedom of Information and Protection of Privacy Act. For questions about the collection of personal information, contact the FOIP Coordinator at The Evergreens Foundation at 780-865-5444, or mail to The Evergreens Foundation, 101 Athabasca Ave, Hinton AB, T7V 2A4.

Applicant Information
Name*

Applicant’s First NameApplicant’s Last Name
Date of Birth*

MonthDayYear
Date
Telephone
Email Address
example@example.com
Co-Applicant Information
Name

Co-Applicant’s First NameCo-Applicant’s Last Name
Date of Birth

MonthDayYear
Date
Telephone
Email Address
example@example.com
Street*
City*
Province*
Province Postal Code*
SingleMarriedCommon-lawSeparatedWidowed

List all persons who will be living with you should your application be approved:

Rows	First Name	Last Name	Relationship	Birthdate (DD/MM/YYYY)	Occupation/School Grade

YesNo
If YES, please provide the estimated due date

MonthDayYear
Date
YesNo
If NO, provide copies of immigration papers for members who are not Canadian Citizens or Permanent Residents.

Rows	Yes
Indigenous peoples
People with disabilities
Individual fleeing violence or leaving second stage shelter*
At risk of or transitioning out of homelessness*
People dealing with mental health or recovering from addiction*
Youth exiting government care
Veteran
Recent Immigrant or Refugee (in Canada less than 5 years)
Racialized group
Identify with diverse concepts of gender identity and expression or sexual orientation

YesNo
Current Sources of Income (ie. paystubs) (write N/A if not applicable)

Source of Income

Rows	Name of Family Member	Date (From - To)	Gross Monthly Income
Student Grants/Allowance
Unemployment Insurance
Worker’s Compensation
Social Assistance/ Income Support
Other Income (tips, interest, etc)
Department of Veteran Affairs
Old Age Security
Canada Pension
Guaranteed Income Supplement
Alberta Seniors Benefits
Income from Self Employment
Assured Income for the Severely Handicapped (AISH)

Please describe your current situation, including any health and safety concerns. (Provide as much detail and information as possible, as it will assist us with assessing your application)
Note: If you have been given a “NOTICE TO VACATE” please submit a copy of the notice stating the reason for eviction.

Social Assistance Verification Form
YesNo
Please download and print the Social Assistance Verification Form. Have your support worker complete it and return the finished form to Vivian at ahm@theegf.com

Applicants Acknowledgement
I understand that this is an application for accommodation and not an agreement on the part of The Evergreens Foundation to provide me with rental accommodation.

I further acknowledge the right of The Evergreens Foundation, at any time prior to the execution and delivery to me of a lease, to withdraw, or cancel without penalty or liability for damages or otherwise, any prior approval of this application.

I authorize The Evergreens Foundation to investigate all the statements made in this application, being aware that discovery of any false statement may cancel any further consideration of this application.

I further agree that I am obligated to advise The Evergreens Foundation, in writing, of any changes in family composition, gross family composition, gross family income, assets, employment or change of address should occur.

I understand that this information is being collected under the authority of the Freedom of Information and Protection of Privacy ACT (32-C) as is required for the purpose of administering a housing program. Any questions or concerns regarding the use and/or handling of my personal information should be directed to the FOIP Coordinator at The Evergreens Foundation
That I/we have resided in the Province of Alberta (# of years) years of my/our life/lives and in The Evergreens Foundation boundaries (Hinton, Edson, Jasper, MD of Greenview No. 16 (Grande Cache), Yellowhead County, Parkland County West of the Seba Beach turnoff) for (# of years) years.
Applicant Signature*

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Applicant Name*
Full Name
Date*

MonthDayYear
Date
Document Upload*

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Social Housing Application

(Confidential)

Applicant Information

Co-Applicant Information

Social Assistance Verification Form

Applicants Acknowledgement