Short Term Rent Supplement Application
Form
Name
*
First Name
Last Name
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
Date
Pronouns
She, her
He, him
They, them
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Preferred method of contact:
Phone
Email
Voicemail
Please leave me a voicemail about my case
Please do not leave me a voicemail about my case
No preference
Preferred time for communication
Weekday mornings
Weekday afternoons
Housing Information
Select your housing type. You are not eligible if you live in BC-Housing operated housing or receive a BC Housing rent supplement.
Housing Type
Apartment, house, or shared accommodation
You rent and receive no subsidies on your rent
Co-op housing
Currently not housed
PAD rent/RV rental (If you you renting a trailer, and/or RV rental home)
Subsidized housing (you receive subsidies for your rent)
Other
How many bedrooms are you renting in your housing unit?
1 bedroom or less
2 bedrooms
3 bedrooms
4+ bedrooms
Landlord Contact Information
*required
Landlord phone number
*
Please enter a valid phone number.
Landlord email
*
example@example.com
Landlord address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Residency Status
Canadian Citizen
Permanent Resident
Refugee Claimant
Temporary Foreign Worker
Other
Indigenous Status
Non-Indigenous
First Nations
Métis
Inuit
Prefer not to answer
Consent
By checking this box, you are providing consent to CMHA Kelowna to obtain your information and release it to BC Housing, which is a requirement in dispersing a rent subsidy.Applications are processed on a first-come, first-served basis, subject to approval and funding availability. A CMHA Kelowna Prevention & Diversion team member will reach you within 5-10 business days.
Consent
*
I consent
Submit
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