Housing Application - COL Social Services Housing Application

Step 1 of 13

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Unique ID

To determine your eligibility to move in or add a member to an existing household, please fill out the form below.

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Status

Applicant Information

Legal Name(Required)

First Last

Preferred Name (Optional)

Gender(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Social Insurance Number

Sorry... You must be at least 16 years of age to complete this application

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Age (years)

Home Phone Number

Cell Phone Number

Work Phone Number

Proof of Canadian Citizenship(Required)

Please upload proof of Canadian Status/Citizenship for this member of the household. Examples include Passport, Birth Certificate, Permanent Resident Card.

* Driver's Licenses, Health Cards and Photo ID cards are not accepted.

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 10 MB.

Pregnancy

I am expecting a baby

Expected Due Date(Required)

DD slash MM slash YYYY

Proof of Pregnancy

Letter from your doctor or healthcare professional confirming your pregnancy and estimated due date

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 10 MB.

Current Address for

NFA

I currently have No Fixed Address

Current Address(Required)

Street Address Unit Number City Province / State / Region Postal / Zip Code Country

Since When (MM/YYYY)

Is this a Rent Geared-to-Income Housing unit?(Required)

Yes

Please provide a letter from your Housing Provider verifying you are up to date with your rent.

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 16 MB.

Name of Housing Provider

Are there any arrears owing?(Required)

Yes

Please be advised if you have any outstanding arrears owing, this may affect your eligibility.

Landlord Name

Landlord Phone Number

Accommodation History for

Please list the addresses where you have lived for the past 5 years not including your current address. If you have experienced homelessness during any point in the last 5 years, please indicate that as well.

Accommodation History

Address	Dates Lived Here	Rent Geared to Income	Actions

There are no Accommodations.

Maximum number of accommodations reached.

Correspondence Information

I prefer to be contacted by

Mail

Email Address(Required)

Mailing Address

My Mailing Address is different than my Current Address

Mailing Address(Required)

Street Address Unit Number City Province / State / Region Postal / Zip Code Country

Alternate Contact Information

Name of person you give us permission to contact in your absence to speak to about this application

Phone Number

Relationship to you (family member, friend etc.)

Income Information for

Annual Income for

Please enter the amount shown on Line 15000 of your Notice of Assessment

Notice of Assessment Upload

Please upload your NOA here

Drop files here or

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 10 MB, Max. files: 1.

List all money you receive each month. Listing all income is mandatory

If you do not have any income, please choose that as an option.

Documentation to verify your current income must be attached to your application.

You will be required to provide a copy of your most recent Notice of Assessment from the Canada Revenue Agency. If you do not have a copy of this assessment, you can request one by calling the Canada Revenue Agency at 1-800-959-8281.

Click the button below to add additional sources of income

No Income

I have no Income

Income Sources

Type of Income	Gross Monthly Income ($)	Proof of Income	Actions

There are no Income Sources.

You must add at least 1 income source.

Asset Information for

List all Assets owned by you. You do not need to include personal vehicles. Listing all assets is mandatory.

If you do not have any assets, please choose that as an option.

Documentation to verify all of your assets must be attached to your application.

No Assets

I have no Assets

Assets

Type of Asset (including those in foreign countries)	Details of Asset	Value/Account Balance ($)	Proof of Assets	Actions

There are no Assets.

You must add at least 1 asset.

Do you own any property?

Yes

A household must sell their interest in the property within 180 days of starting to receive rent geared-to-income assistance. If your residence is sold while you're on the waiting list, please provide a copy of your disbursement list to review your continued eligibility for rent geared-to-income assistance.

Owned Properties

Property Location	Type of Property	Assessed Value	Mortgage Owing	Documentation to verify Current Value and Current Mortgage	Actions

There are no Properties.

Maximum number of properties reached.

Declaration, Release and Consent of Information

I declare that all information given in this application is correct and complete. I understand that falsifying information may result in the cancellation of my application, tenancy or occupancy.

Any changes to the information on this application must be reported in writing within 30 days to the Housing Services Department. Failure to do so will result in the cancellation of my application or the loss of position on the waiting list.

This application and any requested supporting documents become the property of The Corporation of the County of Lambton, Housing Services Department. This information will be used to determine eligibility of rent geared-to-income assistance and housing applied for, ongoing eligibility of rent geared-to-income assistance and housing and may be used for the appropriate rent geared-to-income charge.

I acknowledge that my personal information may be shared with various program participants as contemplated by s. 14(1)(a) of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56

I understand that the treatment, storage and handling of my personal information is governed by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56.

Personal information contained on this form or in attachments is collected by The Corporation of the County of Lambton pursuant to the Municipal Freedom of Information and Protection of Privacy Act, (R. S. O. 1990, c.M.56). Inquiries relating to this collection should be directed to The Corporation of the County of Lambton, Housing Services Department, 162 Lochiel Street, Suite 100 Sarnia, ON N7T 7W5 or 519-344-2062.

Pursuant to the Municipal/Provincial Freedom of Information and Protection of Privacy Act and the Federal Privacy Act, I give my consent and authorization to The Corporation of the County of Lambton, Housing Services Department to:

• Make inquiries to verify the information given in this application and I authorize any person, corporation or any social agency having knowledge of any such required information to release the information to The Corporation of the County of Lambton, Housing Services Department. I agree to provide any supporting material required for my application.

• Disclose the information given on this form to non-profit housing corporations, co-operatives, and other municipal, provincial and federal departments and agencies providing social assistance to me and persons listed on this application.

• I/We understand that my/our rent and damage arrears information will be shared with the Housing Services Corporation and among other Service Managers through the Housing Services Corporation’s Provincial Arrears Database for the purpose of verifying eligibility for assistance under the Housing Services Act.

Signature(Required)

Household Members

Please list all members who will live in the unit not including the applicant.

Any Household Members?

I have no additional household members

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Household Member Count

Household Members

Legal Name	Gender	Date of Birth	Social Insurance Number	Relationship	Actions

There are no Members.

Maximum number of members reached.

Special Priority Status

Special Priority Status is reserved for applicants who have been abused by another person residing in their household and/or has been a victim of human trafficking. Special Priority Status assists applicants who need subsidized housing to permanently separate from the abusing individual.

To apply for Special Priority Status you must complete the Victim of Domestic Abuse and/or Human Trafficking Verification form. As part of applying for Special Priority Status, a qualified professional must complete specific sections of the Victim of Domestic Abuse and/or Human Trafficking Verification form. Proof of cohabitation with the abuser must also be provided for Victims of Domestic Abuse.

Would you like us to send you a form for Special Priority Status?(Required)

Yes

Would you prefer the form to be mailed or emailed?(Required)

Mail

Address

Please provide a safe email or mailing address below

Street Address Unit Number City Province / State / Region Postal / Zip Code Country

Phone Number

Is it safe to leave voicemails

It is safe to leave me voicemails at this number

Medical Requirements

Does any member of the household require a building with an elevator?(Required)

Yes

Do you require a unit on a certain floor?(Required)

Yes

Which Floor?(Required)

Does any member of the household have a medical requirement for a wheelchair modified unit?(Required)

Yes

Medical Requirements

Select Member of the household that requires wheelchair modified unit

Medical Note

Please provide a detailed medical note from your Doctor or Healthcare Professional which clearly specifies the reason you require the accommodation

Drop files here or

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 10 MB.

Add Another Medical Note

Do you require an extra bedroom for any of the following reasons:

Select all that apply

To store medical equipment required by a member of the household because of a disability or medical condition

A spouse requires a separate bedroom because of a disability or medical condition

Medical Note

Please provide a detailed medical note from your Doctor or Healthcare Professional which clearly specifies the reason you require the accommodation

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 16 MB.

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Does any member of the household require support services in order to live independently?

Yes

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Support Agency Letter

If you are able, please provide a letter form your Support Agency outlining the supports you require.

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 16 MB.

Supported units are units that are associated with March of Dimes, Community Living or Lambton County Developmental Services where individuals receive specific services from these agencies to assist them in living independently.

Does any member of the household require support services in order to live independently?

Yes

Support Agency(Required)

Please identify the household member and the supports they require

If you have an approval letter from the agency, please upload here

Accepted file types: jpg, jpeg, gif, png, heic, pdf, doc, docx, Max. file size: 16 MB.

A household is eligible for the largest unit with one bedroom for every two spouses and one additional bedroom for each extra household member. Please indicate your preferred unit size by checking all that apply.

Bachelor

1 Bedroom

2 Bedroom

3 Bedroom

4 Bedroom

5 Bedroom

You will receive one (1) offer of housing. If you decline this offer, you may be removed from the waitlist. Please carefully select only options you are willing to accept.

For questions about your preferences, medical accommodations, or additional information about building complexes, please call the Access Coordinator at 519-344-2062, ext. 2200.

Please click and select the location(s) where you would like to live. If you select locations for which you are not eligible, your name will not be placed on those waiting lists.

Sarnia

Alexander MacKenzie

1625 Afton Court

Sarnia, Ontario, N7S 5Y6

View on Map

Building Type

Townhouse

Unit Sizes

2 Bedroom
3 Bedroom

Program

Co-operative Housing Provider
Rent Supplement Units

Amenities and Notes

Utilities Extra

Pet Deposit

Security Deposit

Laundry Hookups

Faethorne

1240 Afton Drive

Sarnia, Ontario, N7S 1P3

View on Map

Building Type

Townhouse, Apartment

Unit Sizes

1 Bedroom
2 Bedroom
3 Bedroom

Program

Co-operative Housing Provider
Non Profit Housing Provider

Amenities and Notes

Pet Restrictions *

Pet Deposit

Security Deposit

Elevator

Wheelchair Modified Units

Laundry Facilities

* No Dogs

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Canterbury Court

Sarnia, Ontario,

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom
2 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Hydro Extra

Laundry Facilities

Elevator (1 Building)

Walk-Up (3 Buildings)

Capel Manor

230 Capel Street

Sarnia, Ontario, N7T 7P9

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Elevator

Laundry Facilities

Jubilee Gardens

700 Cathcart Boulevard

Sarnia, Ontario, N7V 2N5

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Laundry Facilities

LULA Lift Available

Wheelchair Modified Units available:

1 Bedroom

925 Colborne

925 Colborne Road

Sarnia, Ontario, N7V 3K4

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom
2 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Walk-Up

No Balconies

Valley View

914 Confederation Street

Sarnia, Ontario, N7S 1A1

View on Map

Building Type

Townhouse

Unit Sizes

2 Bedroom
3 Bedroom
4 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Appliances not Included

Copland

747 Copland Road

Sarnia, Ontario, N7T 7B6

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

Rent Supplement Units
Supported

Amenities and Notes

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

Devine Street

244 Devine Street

Sarnia, Ontario, N7T 2R7

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Appliances not Included

Laundry Hookups

Fenced in yard for ground floor apartment

Fenced in concrete patio for upstairs apartment

Grass maintained by County of Lambton

Avondale Apartments

125 Euphemia Street South

Sarnia, Ontario, N7T 2Y6

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Elevator

Laundry Facilities

Wheelchair Modified Units available:

2 Bedroom

Berean

1445 Exmouth Street

Sarnia, Ontario, N7S 6J5

View on Map

Building Type

Townhouse, Apartment

Unit Sizes

1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Pet Restrictions *

Laundry Facilities

Utilities Extra (Townhouse)

Elevator (Apartments)

* 1 pet policy (max 20 lbs/20", spayed/ neutered, up-to-date vaccines)

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Nottingham Towers

56 Finch Drive

Sarnia, Ontario, N7S 5K8

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Building Type

Apartment

Unit Sizes

1 Bedroom
2 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Heat Extra

Hydro Extra

Elevator

Laundry Facilities

Kathleen Adult

Kathleen Avenue

Sarnia, Ontario,

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Laundry Facilities

Kathleen Semi

Kathleen Avenue

Sarnia, Ontario,

View on Map

Building Type

Semi-Detached Home

Unit Sizes

2 Bedroom
3 Bedroom
4 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Hydro Extra

Appliances not Included

Must Cut Grass

Private Driveway

Laundry Hookups

Kathleen Family

Kathleen Avenue

Sarnia, Ontario,

View on Map

Building Type

Townhouse

Unit Sizes

2 Bedroom
3 Bedroom
4 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Utilities Included

Appliances not Included

Laundry Hookups

Wheelchair Modified Units available:

2 Bedroom

Cardiff Acres

Scattered Units

Sarnia, Ontario,

View on Map

Building Type

Townhouse, Detached Home, Semi-Detached Home

Unit Sizes

3 Bedroom
4 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Hydro Extra

Appliances not Included

Laundry Hookups

Wheelchair Modified Units available:

3 Bedroom

Bethel Manor

1575 London Line

Sarnia, Ontario, N7T 7H2

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Smoke-Free Property

Pet Restrictions *

Elevator

65 Years Old +

* 1 pet policy (max 20 lbs/20", spayed/ neutered, up-to-date vaccines)

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Maxwell Park Place

993 Maxwell Street

Sarnia, Ontario, N7S 0C5

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit
Supported

Amenities and Notes

Smoke-Free Property

Elevator

Laundry Facilities

65 Years Old +

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

St. Clair Gardens

150 Queen Street

Sarnia, Ontario, N7T 2R1

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Elevator

Laundry Facilities

Guernsey Gardens

124 Queen Street

Sarnia, Ontario, N7T 2R1

View on Map

Building Type

Apartment

Unit Sizes

Bachelor
1 Bedroom

Program

County of Lambton Owned Unit
Supported

Amenities and Notes

Elevator

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

Roger St.

Roger Street

Sarnia, Ontario,

View on Map

Building Type

Townhouse, Semi-Detached Home

Unit Sizes

2 Bedroom
3 Bedroom
4 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Appliances not Included

Must Cut Grass

Laundry Hookups

Ozanam Manor

911 Wellington Street

Sarnia, Ontario, N7T 1J6

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom
2 Bedroom
3 Bedroom

Program

Non Profit Housing Provider
Supported

Amenities and Notes

Elevator

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Northgate Manor

345 Willowdale Crescent

Sarnia, Ontario, N7T 7T5

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Elevator

Laundry Facilities

Alvinston

Alvinston Apartments

3247 River Street

Alvinston, Ontario, N0N 1A0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Arkona

Orchardview Apartments

7294 Arkona Road

Arkona, Ontario, N0M 1B0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom
2 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Smoke-Free Property

Pet Restrictions *

Laundry Facilities

Private patios

65 Years Old +

* 1 pet policy (max 20 lbs/20", spayed/ neutered, up-to-date vaccines)

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Brigden

Brigden Park Place

2444 Jane Street

Brigden, Ontario, N0N 1B0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

Rent Supplement Units
Non Profit Housing Provider

Amenities and Notes

Elevator

Laundry Facilities

65 Years Old +

Corunna

Moore Lodge

203 Fane Street

Corunna, Ontario, N0N 1G0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Forest

Forestview Villa

41 Morris Street

Forest, Ontario, N0N 1J0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Smoke-Free Property

Elevator

Laundry Facilities

65 Years Old +

Sunset Lodge

57 Union Street

Forest, Ontario, N0N 1J0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

Petrolia

Central Apartments

436 Greenfield Street

Petrolia, Ontario, N0N 1R0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Kings Court

412 King Street

Petrolia, Ontario, N0N 1R0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Laundry Facilities

65 Years Old +

Mid Valley

4335 Petrolia Line

Petrolia, Ontario, N0N 1R0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

Rent Supplement Units
Non Profit Housing Provider

Amenities and Notes

Smoke-Free Property

Elevator

Laundry Facilities

60 Years Old +

Lambtonian

3932 Petrolia Line

Petrolia, Ontario, N0N 1R0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom

Program

Rent Supplement Units

Amenities and Notes

Smoke-Free Property

Elevator

65 Years Old +

Point Edward

Huronview Apartments

11 Fort Street

Point Edward, Ontario, N7V 1M1

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Laundry Facilities

No Patios

Sombra

Sombra Apartments

3548 St. Clair Street

Sombra, Ontario, N0P 2H0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Thedford

Meadowview Townhouses

173 Deacon Street

Thedford, Ontario, N0M 2N0

View on Map

Building Type

Townhouse

Unit Sizes

2 Bedroom
3 Bedroom
4 Bedroom
5 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Utilities Extra

Pet Restrictions *

Laundry Hookups

* 1 Pet Max, spayed/neutered, up-to-date vaccines

Wheelchair Modified Units available:

3 Bedroom

Widder Court Seniors

172 Deacon Street

Thedford, Ontario, N0M 2N0

View on Map

Building Type

Seniors Only Apartment Building

Unit Sizes

1 Bedroom
2 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Smoke-Free Property

Pet Restrictions *

Laundry Facilities

65 Years Old +

* 1 pet policy (max 20 lbs/20", spayed/ neutered, up-to-date vaccines)

Wheelchair Modified Units available:

1 Bedroom

Mill Street Singles

76 Mill Street

Thedford, Ontario, N0M 2N0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Pet Restrictions *

Laundry Facilities

Walk-Up

* 1 pet policy (max 20 lbs/20", spayed/ neutered, up-to-date vaccines)

Golden Villa

47 Royal Street

Thedford, Ontario, N0M 2N0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

Laundry Facilities

Watford

Watford Apartments

475 Ontario Street

Watford, Ontario, N0M 2S0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

Ambassador Place

356 St. Clair Street

Watford, Ontario, N0M 2S0

View on Map

Building Type

Townhouse, Apartment

Unit Sizes

1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom

Program

Non Profit Housing Provider

Amenities and Notes

Utilities Extra

Laundry Facilities

Walk-Up

Wheelchair Modified Units available:

1 Bedroom

2 Bedroom

Wyoming

Parkside Apartments

587 Ontario Street

Wyoming, Ontario, N0N 1T0

View on Map

Building Type

Apartment

Unit Sizes

1 Bedroom

Program

County of Lambton Owned Unit

Amenities and Notes

LULA Lift

Laundry Facilities

Wheelchair Modified Units available:

1 Bedroom

Other Options

Portable Housing Benefit

The Portable Housing Benefit (PHB) provides a monthly subsidy to eligible applicants. This benefit allows the household to secure their own accommodations in the private market anywhere in Lambton County.

Let me know of any future housing

I am interested in being contacted for locations not included on this list if they become available in the municipalities that I have shown an interest in.

Please review the below information for errors before submitting

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Additional Comments

Is there any other information you would like to include in this application.

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Existing Application/Household Data

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Existing Application Name

First Last

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Relation to Existing Application

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Existing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Confirmation

Please enter your email if you would like to receive an email confirmation of Application Submission

Name of Family Member	File	Actions

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