SPP | Part C: Verification Record
Relationship to applicant in Part A:
I am working with the applicant around the issue of human trafficking or abuse in my
professional capacity as a:
Registered social worker
Registered social service worker
Registered mental health
therapist or psychotherapist
Registered nurse or registered
Registered early childhood
Minister of religion
I am not a member of one of the above professions, but I am working with the applicant in
my professional role around the issue of human trafficking or abuse. I understand that I
must have this Verification Record signed by a person who has the authority to
bind my agency or organization.
I do not work with the applicant in a professional role, but I have direct knowledge that the
applicant has been subject to human trafficking or abuse. I understand that I must have
this Verification Record and my letter of support notarized as to the truth of the
records by a commissioner for taking affidavits.
Reminder to person completing Verification Record:
• You must attach a letter of support outlining the instances of human trafficking or abuse,
including timelines. This letter is mandatory.
• If you are not working with the applicant in your professional role, you must have this
Verification Record and your letter of support notarized as to the truth of the records by a
commissioner for taking affidavits.
Name of person completing Verification Record: __________________________________
Signature: _______________________________________________ Date: ______________
Name of person who can bind agency: __________________________________________
Title: ____________________________ Agency: __________________________________
Signature: _______________________ Date: _____________________________________
This information is collected under the legal authority of the Housing Services Act, 2011 for the purpose of
administering social housing programs prescribed in this Act and its associated Regulations. Questions about this
collection should be forwarded to the Director of Housing Services, Region of Durham at 605 Rossland Rd E,
Whitby ON L1N 6A3 or 905-668-7711.