Applicants Name

Phone Number

Date of Birth

Email

Are you applying for a particular home or location? If so please specify

Marital Status Marital Status Married Common-Law Divorced Single Separated Widowed

List all current household members names, age, and sex.

Current Address, province, postal code

Number of years at current address

If you own your residence what is your monthly Mortgage payment per month?

Do you own any other real estate? Do you own any other real estate? Yes no

If you rent what is your rent payment? *Please supply a copy of your lease OR recent receipt Or cancelled rent Cheque

Landlords Name?

Landlord's Full Address

Landlords Phone Number

Co-Applicants Name (if applicable)

Phone Number

Date of Birth

Marital Status Marital Status Married Common-Law Divorced Single Separated Widowed

Current Address, province, postal code

Number of years at address

Please Check other rooms that you have in your current dwelling. Please Check other rooms that you have in your current dwelling. Kitchen Bathroom Living Room Dining Room Basement Other

Please describe other room

If you rent what is your monthly payment?*

Please describe the condition of the dwelling you currently live in.

How is your current house situation not meeting your needs?

Are there special needs that you would consider in choosing or building a house - i.e. accessibility, room for grandparents etc. ? Are there special needs that you would consider in choosing or building a house - i.e. accessibility, room for grandparents etc. ? yes No

If yes please indicate needs

Are you currently employed? Are you currently employed? Yes No

Name of applicants current employer

Address of current employer

Phone Number of current employer

Your Position Title

Part-time hours per week

Full-time hours per week

Years at current job

Name of previous employer

Previous employers address

Previous employer address

Previous position title

Part-time hours pers week

Previous full-time hours per week