Housing Application

Step 1 of 8

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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)

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)

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: 256 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.

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

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.

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)

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

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

Name of Family Member	File	Actions

There are no Documents.

Applicant Information

Current Address for

Accommodation History for

Correspondence Information

Alternate Contact Information

Income Information for

Asset Information for

Declaration, Release and Consent of Information

Household Members

Special Priority Status

Medical Requirements

Sarnia

Alexander MacKenzie

Building Type

Unit Sizes

Program

Amenities and Notes

Faethorne

Building Type

Unit Sizes

Program

Amenities and Notes

Wheelchair Modified Units available:

Canterbury Court

Building Type

Unit Sizes

Program

Amenities and Notes

Capel Manor

Building Type

Unit Sizes

Program

Amenities and Notes

Jubilee Gardens

Building Type

Unit Sizes

Program

Amenities and Notes

Wheelchair Modified Units available:

925 Colborne

Building Type

Unit Sizes

Program

Amenities and Notes

Valley View

Building Type

Unit Sizes

Program

Amenities and Notes

Copland

Building Type

Unit Sizes

Program

Amenities and Notes

Wheelchair Modified Units available:

Devine Street

Building Type

Unit Sizes

Program

Amenities and Notes

Avondale Apartments

Building Type

Unit Sizes

Program

Amenities and Notes

Wheelchair Modified Units available:

Berean

Building Type

Unit Sizes

Program

Amenities and Notes

Wheelchair Modified Units available:

Nottingham Towers

Building Type

Unit Sizes

Program

Amenities and Notes

Kathleen Adult

Building Type