Fillable KEKINOW NATIVE HOUSING SOCIETY

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KEKINOW NATIVE HOUSING SOCIETY

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Country of origin: CANADA
File type: PDF

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When is the last day of your tenancy? ______________________________________________
KEKINOW NATIVE HOUSING SOCIETY
1014 - 7445 132
nd
Street, Surrey, BC V3W 1J8
P: 604.591.5299 | F: 604.591.5112 | E: info@kekinow.ca | W: www.kekinow.ca
PERSONAL INFORMATION: Application Date: _______________
Full Name: ___________________________________________________________________________
Present Address: ______________________________________________________________________
Telephone Number: ____________________________ Cellular Number: ________________________
Email Address: ___________________________________ Date of Birth: ________________________
Do you have aboriginal ancestry? Yes No Band or Status Number _________________________
Have you lived in KNHS before? Yes No
Are you applying for subsidized housing? Yes No
Please indicate which city you would like to live in Surrey Chilliwack
CO-APPLICANTS
INFORMATION:
Full Name: ___________________________________________________________________________
Telephone Number: _______________________________ Date of Birth: ________________________
Other Persons Relationship to Applicant
DOB (YYYY/MM/DD)
Do you or a family member require an accessible suite due to a disability? Yes /
No
Are you currently in low income housing? Yes / No
Do you rent or own your current home? Rent / Own
If you rent, have you been served with an eviction notice? Yes/No (If yes, answer below)
Why are you being evicted? ______________________________________________________
Code
REV201901
Application Form
-
-
-
-
OR (check all that apply)
Temporary housing
Living with family/friends
Overcrowding
Inadequate bathroom facilities
Inadequate kitchen facilities
Unsafe Environment
Breakdown of relationship
Unaffordable
Health affected
Homeless
Additional Information:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Most recent rental Information (Landlord information required)
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Telephone Number: ____________________________ How Long: _____________________________
REFERENCES (must not be a family member)
One employment and two rental references are required
Name Relationship Telephone Number
FINANCIAL INFORMATION:
1.
Source of Income _______________________________ Monthly $ ____________________
2.
Source of income _______________________________ Monthly $ ____________________
3.
Source of income _______________________________ Monthly $ ____________________
Amount of rent including utilities $ ________________________
List any other major expenses ___________________________________________________________
REV201901
Application Form
<< MUST READ INFORMATION >>
•
All KNHS housing is non-smoking
•
Incomplete applications will not be accepted
•
Applicants must contact our office every 6 months to remain active on the waitlist
•
Applicants must update the application if there are any changes such as contact information
<< OFFICIAL DECLARATION AND PERMISSION FOR VERIFICATION OF INFORMATION >>
I/We understand that all the information provided herein is held in strict confidence with KNHS, and this
application will be available to me/us upon my/our request.
I/We understand that is my/our responsibility to ensure this application is kept updated should I/We
change addresses/telephone numbers. Failure to update this application at least once every 6 months
will result in my/our application being put on the inactive list. Reactivations will commence when the
application is updated.
I/We hereby authorize KNHS to obtain any information required concerning the above statements and
application hereon.
I/We further agree to sign and abide by a “Residential Tenancy Agreement” including all Rules and
Regulations of the Society and the building/project.
I/We understand that accommodation availability is subject to placement on a wait list and that the
Society does not provide emergency shelter, nor can the Society accommodate urgent referrals from
other agencies.
______________________________________
Applicants Signature
______________________________________
Date
______________________________________
Co-Applicants Signature
______________________________________
Date
Please return your application by: mail, email, or in person to:
KEKINOW NATIVE HOUSING SOCIETY
1014 - 7445 - 132nd Street, Surrey, BC V3W 1J8
P: 604.591.5299 | F: 604.591.5112 | E: info@kekinow.ca | W: www.kekinow.ca
For office use only
Received by: Followed up by:
Reviewed by:
Subsidized Affordable
REV201901
Application Form
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then email the completed form to: info@kekinow.ca
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KEKINOW NATIVE HOUSING SOCIETY

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Completed 26 April 2022

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