Residential Services Application/Referral - Part 1
Community and Social Services
Part 1- Applicant Information (Form CS-RS 893E)
Residential Services, also known as domiciliary hostels, are private or non-profit residences that provide long-
term housing to vulnerable adults who require some supervision and services to maintain their independence
in the residence. Services include: furnished rooms, 24-hour urgent response, medication management, meals
and snacks, housekeeping and personal laundry, social and/or recreational activities.
To apply for a Residential Services subsidy, a person must complete an application form. The application is
divided into two parts:
If you are unable to print the application (Part 1- Applicant Information and Part 2 - Health Information), you
may request a paper copy by e-mailing CommunitySupports@ottawa.ca
or by calling 613-580-2424, extension
26586 and one will be mailed to you.
Read the Instruction Guide (Form CS-RS 892E) found on ottawa.ca before completing the
application form. The guide provides detailed information and step by step instruction
on how to fill out the application.
Send the completed application to the City of Ottawa Community Supports
Once you have both the Applicant Information (Sections 1A to 1E) and the Health Information (Sections 2A to
2D) completed, submit both forms to Community Supports by e-mail, fax or mail.
E-mail (scan copy): CommunitySupports@ottawa.ca
Mail: Community Supports, 370 Catherine Street, Ottawa, ON K1R 5T5
Page 1 of 7
• Part 1: Applicant Information (Form CS-RS 893E)
• Part 2: Health Information (Form CS-RS 894E)
• The applicant must consent to the release of information by completing and signing
Section 2A of the Health Information form
• Sections 2B to 2D must be completed by a health care professional such as a
doctor (for example family doctor, psychiatrist, neurologist), nurse or social worker.