Online Housing Application

For Cowichan Tribes On-Reserve Housing

PLEASE UNDERSTAND THAT COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE YOU WILL BE PLACED IN A RENTAL UNIT

Please answer questions to the best of your ability.

Providing as much information as possible, even if it is not required, can help to fast track your application.

FOR ANY QUESTIONS, OR FOR HELP FILLING OUT AN APPLICATION:

Call (250) 715-3302 or Contact Us Here

Date Required

Americas/Chicago

Are you applying for a Rental Home or a CMHC Rent to Own Home? Required

Rental

CMHC

Both

(1) Applicant Information

Please note: Only Cowichan Band Registered Members are eligible for On-Reserve Housing

Full Name Required

Birthdate Required

Americas/Chicago

Primary Phone Number Required

Current Home Address

Address 1

Address 2

City

Country

State/Province

Postal Code

Marital Status Required

Single

Married

Common-Law

Separated

Divorced

Widowed

Band Name Required

Registry Number Required

I authorize my Phone Number and Email to be used for contact purposes.

(2) Employment/Income

Please note: All tenants and applicants are required to resubmit information every 6 months.

Employer Required

Employer Phone Number Required

Employer Address Required

Number of Years Employed Required

Total Monthly Income Required

Please provide three (3) examples of proof of income:

Examples include paystubs, letter from employer, tax records, bank statement, government benefit statement or recent hydro bill.

(1) Income: (Social Assistance/Work)

Amount

(2) Child Tax

Amount

GST

Amount

(3) Spouse/Co-Applicant Information

Full Legal Name

Birthdate

Current Home Address

Address 1

Address 2

City

Country

State/Province

Postal Code

Current Employer

Total Monthly Income

No. Years Employed

Band Name

Registry Number

(4) Additional Household Members/Dependants

For each additional member, list Full Legal Name, Relationship to Applicant, Registry Number, Gender and Birthdate.

List additional household members here:

Would you like to declare any other household member income?

Yes

If so, please list the houshold member, their income source(s) and monthly gross income (amount before deduction):

Do you expect your family size to change in the next 12 months? Required

Yes

If yes, explain:

Have you completed a Ready to Rent course?

Yes

Date Completed:

Are you an approved Foster Parents and plan to continue providing foster supports?

Yes

Details:

(5) Present Living Situation

Which best describes your present living situation? Required

If other, please explain:

Please select which best describes your current type of housing: Required

Monthly Rent Required

Mortgage Payments

Does Rent include Utilities? Required

Yes

If no, how much are monthly utilities?

What portion of the rent do you and those on this application pay per month? Required

Number of Bedrooms Required

Number of Bathrooms Required

Number of people in home Required

Are there multiple family groups in your home? Required

Yes

If yes, please outline the makeup of the family groups in your home including number of people in family group and their respective ages:

Conditions of present home (Please check all that apply): Required

Good

Poor

Condemned

Overcrowded

Do you have any household pets? Required

Yes

If yes, please list the type (cat, dog, etc) and the weight of each pet:

(6) Reason for Moving

Are you under notice to end your present tenancy? Required

Yes

If yes, please explain:

Do you have a health and safety concern with your current residence? Please explain:

(7) Health and Mobility

Do you or any members of your household have restrictions with stairs? Required

Yes

Do you or any members of your household use a wheelchair or scooter? Required

Yes

If yes, who?

If a wheelchair is used, is it used inside of the home?

Yes

Can your household members access and function in all areas in your current home? Required

Yes

Do you currently receive home support? Required

Yes

Home Support Provider:

Other than mobility concerns, do you or anyone in your household have a health concern or disability? Required

Yes

If yes, please list the name of the individual and briefly describe their health concern or disability:

(8) Residence History

Please list at least (1) prior residence below:

Include Address, Dates Occupied, Landlord's Name and Contact #: Required

Have you ever lived in subsidized housing? Required

Yes

If yes, where and when?

(9) Lands

Do you have a Certificate of Possession? Required

Yes

In Process

(10) Additional Information

In one or two paragraphs please explain why you should be chosen as a candidate for a rental unit: Required

(11) Authorized Contact Person

Full Legal Name Required

Contact Number Required

Current Address Required

Relationship Required

(12) Declarations

I/We Declare:

That this is my/our application; and
That the information provided is true and correct to the best of my/our knowledge.

I/We Authorize

The Cowichan Band Housing Program to investigate the information stated in this application;
Release of information (ie: credit references, credit bureau information or financial records) that is needed in order to support my application.

I/We Understand

That, in accordance with Section 33.2 (a) of the Freedom of Information and Protection of Privacy Act, the information on this application may be shared with othe affordable housing providers in order to increase my/our opportunities for rent-geared-to-income housing;
That this application is not an agreement on the part of the Cowichan Band Housing Program or its members to provide me/us with housing;
That if we/I are being considered for an available unit, housing providers will gather additional information in order to assess my/our ability to uphold the obligations of a tenancy agreement and it is my/our responsibility to provide or cause to be provided information requested in this assessment;
That it is my/our responsibility to tell the Housing Department of any changes to the information given in this application and to provide any supporting materials required;
That if false information given by me/us may result in my/our application being cancelled from consideration;
That in order to remain as an eligible applicant on the housing waitlist; I/We must update their income yearly, and keep all other information updated as required.

(13) Signatures

Applicant Name (Print in Full) Required

Signature Required

My checking this box I am signing as the Applicant for this application.

Date Required

Co-Applicant (Print Full Name)

Signature

By checking this box I am signing as Co-Applicant for this application.

Date

Online Housing Application

Online Housing Application

For Cowichan Tribes On-Reserve Housing

(1) Applicant Information

*Please note: Only Cowichan Band Registered Members are eligible for On-Reserve Housing*

(2) Employment/Income

*Please note: All tenants and applicants are required to resubmit information every 6 months.*

Examples include paystubs, letter from employer, tax records, bank statement, government benefit statement or recent hydro bill.

(3) Spouse/Co-Applicant Information

(4) Additional Household Members/Dependants

For each additional member, list Full Legal Name, Relationship to Applicant, Registry Number, Gender and Birthdate.

(5) Present Living Situation

(6) Reason for Moving

(7) Health and Mobility

(8) Residence History

(9) Lands

(10) Additional Information

(11) Authorized Contact Person

(12) Declarations

(13) Signatures

Please note: Only Cowichan Band Registered Members are eligible for On-Reserve Housing

Please note: All tenants and applicants are required to resubmit information every 6 months.