Housing Pre-Application

Long Term Housing Pre-Application

Check the box that best reflects your circumstances

Are you currently fleeing domestic violence or abuse?

Yes

Have you ever experienced any form of abuse?

Yes

Are you at risk of violence?

Yes

Are you currently staying in transitional housing?

Yes

Applicant Details

First Name

Middle Name

Last Name

Please list any other names you may be known as

Date of Birth

Address

City

Province

Postal Code

Country

Please check your preferred method of communication

Phone

Is it safe to leave messages?

Yes

Emergency Contact Information

First Name

Last Name

Phone Number

Relationship to you

Household Compostion

Please list all of those who will be living in your household. (Include their name, date of birth, gender and their relationship to you)

Are you expecting your family size to change in the next year? (Birth of a child, Back to care plan, etc.)

Yes

Describe your curent housing circumstances?

Briefly describe your reason for applying

Do you have any pets?

Yes

Do you consent to receiving emails and phone calls regarding your application status?

Yes

Read this statement and sign below

I certify that my answers are true and complete to the best of my knowledge.

I understand that this application does not constitute an agreement on the part of Tamitik Status of Women Association to provide me with accommodation.

Follow Up

If and when there is a suitable vacancy, we will contact you to complete an application form and to set up an interview.

It is the applicants responsibility to advise the Tamitik Status of Women Association is any of the provided information has changed. Please advise these changes in email to info@tamitik.ca

Your expression of interest will be kept on file for 12 months, and then will be shredded after this time due to the sensitive nature of the information disclosed on the application.

Applicant Name

Initials as Signature

Date Signed