If you are interested in applying to live in the Villages, please print and complete the form below and bring or send to Kiwanis Villages Office 635 Pidcock Avenue Courtenay BC V9N 3E4
The Village Office is open Monday though Thursday from 9.00 a.m through 1.00 p.m..
If, for some reason, you are unable to print the form we suggest you write or phone the Village Office (250-338-8651) or call in to collect a form. They are also available at all times from a box outside the Office
The Village Office is open Monday though Thursday from 9.00 a.m through 1.00 p.m..
If, for some reason, you are unable to print the form we suggest you write or phone the Village Office (250-338-8651) or call in to collect a form. They are also available at all times from a box outside the Office
APPLICATION FOR ACCOMMODATION
LOW INCOME SENIORS (Age 55 years and over)
This application form is designed to collect specific information from applicants seeking affordable housing in accordance with section 26(c) of the Freedom of Information and Protection of Privacy Act (FOI Act). The Kiwanis Village Societies will use this information to determine your eligibility for housing and the type of accommodation that best suits your needs.
Kiwansi9 Village is a complex of 64 small (375 to 600 sq.ft) housing units intended specifically for low income seniors, and located within walking distance of Courtenay's Fifth Street shopping area. The Kiwanis Village facilities include a large social & meeting hall, central laundry facilities and a billiard room. Some units have very limited on-site storage. Parking spaces are limited. Residents must be able to live independently, must be non-smokers, and are responsible for their own utilities expenses. In addition, Kiwanis Village allows no pets.
Please include all information requested or your application may not be considered.
PLEASE PRINT CLEARLY
Kiwansi9 Village is a complex of 64 small (375 to 600 sq.ft) housing units intended specifically for low income seniors, and located within walking distance of Courtenay's Fifth Street shopping area. The Kiwanis Village facilities include a large social & meeting hall, central laundry facilities and a billiard room. Some units have very limited on-site storage. Parking spaces are limited. Residents must be able to live independently, must be non-smokers, and are responsible for their own utilities expenses. In addition, Kiwanis Village allows no pets.
Please include all information requested or your application may not be considered.
PLEASE PRINT CLEARLY
| Last Name (Applicant): | First Name: | Date of Birth |
| Last Name (if Sharing accommodation): | First Name: | Date of Birth: |
This application will be kept on file for ONE YEAR ONLY. If, at the end of one year, you have not been considered and you still wish to be considered for Kiwanis Villages housing, you must complete and submit a new application form
Phone#: Day _________________________ Evening ________________________
Email Address: ______________________________
Alternate Contact Person: _________________________________________
Name, relationship to you & phone #
Present Address
_________________________ __________________ _________ ________
__
(# and Street) (City) (Province) (Postal Code)
Mailing Address (if different from above)
_________________________ __________________ _________ ________
(# and Street) (City) (Province) (Postal Code)
Email Address: ______________________________
Alternate Contact Person: _________________________________________
Name, relationship to you & phone #
Present Address
_________________________ __________________ _________ ________
__
(# and Street) (City) (Province) (Postal Code)
Mailing Address (if different from above)
_________________________ __________________ _________ ________
(# and Street) (City) (Province) (Postal Code)
| How many years have you lived in the Comox Valley: | When? | How many years have you lived in other parts of BC: | When? | How many years have you lived in other Provinces: | When? |
DO YOU SMOKE (circle): Yes No If you have quit, how long ago .............
Present Accommodation (circle): Own Rent Share
LOCATION: _____________________________________________
Present landlord (if applicable)
Name: _______________________________ Phone# ____________________
Address: ___________________________________________________________
Number of Bedrooms _______ MONTHLY RENT $ ______________
Does your rent include (circle): HEAT Yes No ELECTRICITY Yes No
MONTHLY UTILITIES $ ___________________
Have you been told to vacate (circle)? YES NO
(If yes, please attach a copy of the notice and reason
Please explain why you wish to move to the Kiwanis Village .....................................................
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Accommodation Required For (circle) SINGLE or SHARED
FINANCIAL INFORMATION (gross monthly income before deductions)
| SOURCE: | AMOUNT (Applicant) | AMOUNT (Shared) |
| Old Age Pension | ||
| Federal/Provincial Supplements (income assistance, PWD) | ||
| Canada Pension (CPP) | ||
| Superannuation/Other Pension or Annuities | ||
| Employment | ||
| Interest and other types of income received | ||
| TOTAL MONTHLY INCOME |
______________________________________________________________________
| ASSETTS | AMOUNT (Applicant) | AMOUNT(Shared) |
| BANK BALANCE (all accounts) | ||
| CAPITAL ASSETS (real estate, bonds, stocks, RRSP's etc.) | ||
| SALE OF PROPERTY |
NOTE: If you are contacted for a personal interview you will be required to provide:
* your most recent Income Tax Notice of Assessment from Revenue Canada
* current bank & other financial statements
* two (2) pieces of identification (picture ID preferred)
LIST THREE REFERENCES
(include two previous landlords & one character reference, no family members please)
* your most recent Income Tax Notice of Assessment from Revenue Canada
* current bank & other financial statements
* two (2) pieces of identification (picture ID preferred)
LIST THREE REFERENCES
(include two previous landlords & one character reference, no family members please)
| References | NAME | PHONE# |
| Landlord 1 Address | ||
| Landlord 2 Address | ||
| Character reference and relationship to you |
ADDED INFORMATION:
(Special needs, doctor’s letter, allergies, wheel chair, disabilities, etc.)
(attach extra pages if necessary)
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DECLARATION: PLEASE READ AND SIGN THE FOLLOWING STATEMENT
I / we declare:
That this is my application and that all the information in it is correct and complete to the best of my / our knowledge and belief.
I / we authorize:
a) Pursuant to the Freedom of Information and Protection of Privacy Act (the FOI Act), the Kiwanis Villages Societies to make any enquiries that are necessary to verify the information given in this application;
b) Pursuant to the Freedom of Information Act, any person, corporation or social agency to release to the Kiwanis Villages Societies any information pertinent to the assessment of my/our application; and
c) The Kiwanis Villages Societies to receive and exchange with credit bureaus and my/our previous landlords, credit and other information about me/us, to be used in the decision making process to provide me/us with rental accommodation.
I/we understand:
a) that this application does not constitute any agreement of the part of the Kiwanis Villages Societies to provide me/us with rental accommodation; and
b) that it is my/our responsibility to advise the Kiwanis Villages Office of any changes to the information given in this application and to provide any supporting materials required for my /our application.
SIGNED: __________________________________________________________
DATE ________/_______/____________ Day Month Year /22-02-2015/
