Apply for

Community Housing

Please keep in mind that placement is determined by need rather than the date of application.

Community Housing Application

Complete all questions, supplying all of the requested information. Your completed application must be signed in the presence of a Commissioner of Oaths in and for the Province of Alberta. This service is provided at our office at no charge.

You must provide the following with your application in order for it to be processed:

A copy of a picture ID for the applicant.
A copy of the current year of Notice of Assessment for all adults in the household.
A copy of valid Alberta Health Care Cards for all members of your family.
A copy of your lease or rental agreement
A copy of your Permanent Resident card, if you are not a Canadian citizen.

Step 1 of 11

Personal Information

Primary Applicant's Name:(Required)

First Name Last Name and Middle Initial

Home Phone Number:

Cell Phone Number:

Email Address(Required)

Social Insurance Number:(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Other

Marital Status:(Required)

Married

Single

Divorced

Common Law

Seperated

Other

Current Address:(Required)

Street Address City Province Postal Code

Is your Mailing Address different from the address listed above?(Required)

Yes

Mailing Address, if different from above:

Street Address City Province Postal Code

Are you a Canadian Citizen?(Required)

Yes

If No, please upload a copy of your Immigration Papers.

Max. file size: 4 MB.

Do you need an interpreter?(Required)

Yes

If Yes, Interpreters Name:(Required)

Interpreters Phone Number:(Required)

Household Composition

List all individuals applying on this application who will be living in the subsidized unit, not including the primary applicant listed above.

How many additional applicants will be living in the subsidized unit?(Required)

1st Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Other

Currently living with the Primary Applicant?

Yes

2nd Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Other

Currently living with the Primary Applicant?

Yes

3rd Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Social Insurance Number(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Other

Currently living with the Primary Applicant?

Yes

4th Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Social Insurance Number(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Other

Currently living with the Primary Applicant?

Yes

5th Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Social Insurance Number(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Currently living with the Primary Applicant?

Yes

6th Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Social Insurance Number(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Currently living with the Primary Applicant?

Yes

7th Applicant Name(Required)

First Last

Relationship to Applicant(Required)

Social Insurance Number(Required)

Birth Date:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

Transgender

Currently living with the Primary Applicant?

Yes

Do your children live with you full time?(Required)

Yes

I do not have children.

If No, please explain:(Required)

Is anyone in the household pregnant?(Required)

Yes

If Yes, what is the Due Date:(Required)

MM slash DD slash YYYY

Please upload a copy of Doctor’s note.

Accepted file types: pdf, jpg, png, Max. file size: 4 MB.

If you are unable to upload a copy of the doctor's note currently, please note a copy will be required as part of your application submission in order for it to be processed.

Are you sharing any part of your current accommodation with person(s) not applying on this application?(Required)

Yes

How many additional Adults not listed above?(Required)

How many additional Children not listed above?(Required)

What part of the accommodation is shared?(Required)

Does anyone in your household have physical limitations and/or medical conditions?(Required)

Yes

Example: Do you require a wheelchair accessible suite?

If Yes, please indicate the limitations:

Is anyone in your household unable to do stairs?(Required)

Yes

If Yes, are you currently living in a household with stairs?(Required)

Yes

Do you have a pet?(Required)

Yes

If yes, what kind(s) and how many of each?(Required)

If Yes, are you willing to find your pet a new home if you are offered housing?(Required)

Yes

Residency

Which best describes your current residence?(Required)

House

Townhouse

Lodge

Shared Residence

Shelter

Apartment

Multiplex

Roomate

Other

Rooms in your present residence:

Kitchen

Living Room

Dining Room

Is your housing unsafe or does it cause health problems for anyone?(Required)

Yes

If you answered yes to your housing unsafe, please explain:(Required)

Number of Bedrooms:(Required)

Number of Bathrooms:(Required)

Do you pay rent?(Required)

Yes

How much do you pay in rent monthly?(Required)

Do you pay for Electricity?(Required)

Yes

Do you pay for Gas?(Required)

Yes

Do you pay for Water?(Required)

Yes

Do you pay for Sewer, Waste, and Recycling?(Required)

Yes

If you don’t pay rent, do you contribute financially?(Required)

Yes

If Yes, provide details:(Required)

Lease expiry date:

MM slash DD slash YYYY

How long have you lived there?(Required)

Describe your current accommodation:(Required)

Please feel free to describe your current accommodation and any information you would like the Newell Housing Association to be aware of. This space is provided for you to explain your reasons for wanting to move into Community Housing or requesting a subsidy and will assist us in the approval of your application.

If you want to move, what are the reasons:(Required)

If you are currently renting, have you been given an eviction notice?(Required)

Yes

If Yes, please list the evictions date:(Required)

MM slash DD slash YYYY

Please upload a copy of eviction notice:

Max. file size: 128 MB.

If you are unable to provide a digital copy of the eviction notice, please provide a physical copy to the Newell Housing Foundation Office in order to complete your application.

Tenant History

List your Tenant History for the 12 month period prior to living in your current residence:

Are you able to provide your tenant history?(Required)

Yes

If No, please explain:(Required)

Address #1

Street Address Address Line 2 City Province Postal Code

Landlords Name:

Landlords Phone:

Move in date:

MM slash DD slash YYYY

Move out date:

MM slash DD slash YYYY

Address #2

Street Address Address Line 2 City Province Postal Code

Landlords Name:

Landlords Phone:

Move in date:

MM slash DD slash YYYY

Move out date:

MM slash DD slash YYYY

Employment and Income

Primary Applicant

Are you currently Employed?(Required)

Yes

If Yes, who are you employed by?(Required)

Company Name Street Address City Province Postal Code

Do you currently have a source of income?(Required)

Yes

Primary Applicants Current Sources of Income:

List all current sources of income (monthly amounts) for everyone 15 years of age and older. In all cases, state gross monthly income (income amount before deductions).

Click the PLUS sign on the right to add more rows

Income Type

Start Date

End Date

Dollar Amount Receiving per Month

Please upload proof of income.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 4 MB.

Proper documentation must support any and all income received by your household. If you are unable to provide a digital copy, please provide a physical copy to the Newell Housing Foundation Society Office in order to complete your application.

Secondary Applicant

Are you currently Employed?(Required)

Yes

If Yes, who are you employed by?(Required)

Company Name Street Address City Province Postal Code

Secondary Applicants Current Sources of Income:

Income Type

Start Date

End Date

Dollar Amount Receiving per Month

Please upload proof of income.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 4 MB.

Tertiary Applicant

Are you currently Employed?(Required)

Yes

If Yes, who are you employed by?(Required)

Company Name Street Address City Province Postal Code

Tertiary Applicants Current Sources of Income:

Income Type

Start Date

End Date

Dollar Amount Receiving per Month

Please upload proof of income.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 4 MB.

Assets

List the value of the following assets that are applicable or state N/A if not applicable. Please state a total value of assets for everyone in the household that is over 15 years old.

Click the PLUS sign on the right to add more rows(Required)

Type of Asset

Total Value $

Total Income or Interest Received per Year

Click the PLUS sign on the right to add more rows

Do you own a house?(Required)

Yes

Equity in House:(Required)

Please upload a copy of your Mortgage Statement.

Accepted file types: pdf, jpg, Max. file size: 4 MB.

If you are unable to provide a digital copy, please provide a physical copy to the Newell Housing Foundation Office in order to complete your application.

Do you own a mobile home?(Required)

Yes

Equity in mobile home:(Required)

Please upload a copy of your Chattel Statement.(Required)

Accepted file types: pdf, jpg, Max. file size: 4 MB.

Do you own or lease a Vehicle?(Required)

Own

Lease

Finance

License Plate Number:(Required)

Year and Model:(Required)

Purchase Date(Required)

MM slash DD slash YYYY

Monthly Payment:(Required)

Value:(Required)

If you do not own/lease a vehicle, what is your main form of transportation?

Is there a 2nd Vehicle in your household?(Required)

Own

Lease

Finance

License Plate Number:(Required)

Year and Model:(Required)

Purchase Date(Required)

MM slash DD slash YYYY

Monthly Payment:(Required)

Value:(Required)

Debts

A list of your debts will help the MHCHS to determine your level of affordability.

List all Debts

Who do you owe?

Amount Owed $

Monthly Payment $

(EG. car loan, credit card debt, student loan, etc).
Leave blank if you currently have no debts.

Click on the right to add more

Total amount owed:(Required)

Contacts

Emergency Contact's Name:(Required)

(Eg. Relative or Friend)

First Last

Emergency Contact's Phone(Required)

Relationship to Emergency Contact:(Required)

Emergency Contact's Address:(Required)

Street Address Address Line 2 City Province Postal Code

Do you have a Social Worker, Counselor, or AISH Worker?

Social Worker

Counselor

AISH Worker

None

Please list their name, address, and phone number:

First and Last Name Street Address City Province

Phone Number:

References

List Three References (Eg. Employer, Landlord, Clergy, Volunteer Work, etc.) Cannot be a member of your family.

If you are unable to provide references, please explain:

#1 Reference Name:

First Last

Reference Type:

Reference Phone Number:

#2 Reference Name:

First Last

Reference Type:

Reference Phone Number:

#3 Reference Name:

First Last

Reference Type:

Reference Phone Number:

Miscellaneous

Have you applied to the Newell Housing Foundation in the past?(Required)

Yes

If Yes, when did you last apply?

MM slash DD slash YYYY

Have you ever been a tenant with the Newell Housing Foundation?(Required)

Yes

For which:

Program

Address or Rent Subsidy Type

When did you leave the program?

Do you have any formal community supports (agency, groups and/or organizations) in place?(Required)

Yes

If Yes, please provide details:(Required)

Additional Information

Please describe the conditions that have led to your application:(Required)

In order for Newell Housing Foundation to effectively assess your circumstances and determine the most suitable program for your household, please describe the conditions that have led to your application. Provide additional information about your current living situation, such as temporary or difficult living arrangements, eviction details if applicable and any special needs (mental, physical or emotional health and/or specific medical concerns). Include any additional comments that would help provide a complete description of your current circumstances:

Required Documents

• If you or any member of your family is receiving Employment Insurance, Workers Compensation, or Social Assistance, a letter or cheque stub from the appropriate office must be attached verifying the amount of the benefit. • Documentation to verify all other sources of income (Other than Family Allowance) i.e. Child Support, oil royalties, etc. • A copy of your most recent pay cheque, benefit cheque, pension cheque, etc. or a stub from these for each member of your family receiving income from any source. • If you are a student, a letter from the registrar of your school verifying your registration as a full time or part time student. This is required for household head, spouse and all dependents over the age of 18 years. • A copy of valid Alberta Health Care Cards for all members of your family. • A copy of your lease or rental agreement • A copy of your Permanent Resident card, if you are not a Canadian citizen.

Attach the proper documentation for any/all supports that apply to your circumstance, along with any adults on this application. The application process cannot be completed until these documents are received.

Accepted file types: jpeg, jpg, pdf, Max. file size: 2 MB.

Consent(Required)

I agree.

I understand that this application does not constitute an agreement on the part of Newell Housing Foundation or its agents, to provide me with rental accommodation or rental subsidy.

I further acknowledge the right of Newell Housing Foundation, or its agents, at any time prior to the execution and delivery to me of a lease hereby applied for, to withdraw, revoke, or cancel, without penalty or liability for damages or otherwise, any acceptance or approval of this application previously made or given.

I hereby authorize Newell Housing Foundation, or its agents, to investigate any or all of the statements made herein, including contacting my landlord or employer, being fully aware that discovery of any false statement shall cancel any further consideration of my application.

I further agree that I am obligated to advise Newell Housing Foundation, or its agents, in writing, of any changes in family composition, gross family income, assets, employments or change of address, should they occur.

All approved applicants will be placed in a suitable housing program based on the highest need first and then in the order in which the application was received. Please note that the Newell Housing Foundation will determine which housing program will best suit your household needs after the initial assessment and approval of your application.

The following information will be used to assess your eligibility for lodge accommodation; it will also be used to establish your priority rating score, which is used to measure our applicants’ levels of need.

This information is being collected and protected in accordance with the Privacy Provisions of the Freedom of Information and Protection of Privacy Act.

This personal information is being collected under the authority of the Alberta Housing Act and by the policy of the Newell Foundation Board of Directors. It will be used for the following reason: determine suitability for residency, determine needs rating and for communication with health care and social agencies that may provide you with care of any type. The privacy provisions of the Freedom of Information and Protection of Privacy Act protect it.

Please be aware that once you have submitted your application online, and included all required supporting documentation, it must be signed in the presence of a Commissioner for Oaths in order to be processed.

Please be aware that once you have submitted your application online, it must be signed in the presence of a Commissioner for Oaths in order to be processed.

Please visit our Central Office at 426 3rd Ave W Brooks, AB T1R 0T9 to sign your application in order for it to be processed.

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