*** ERROR - You have duplicate fieldnames in your form structure ***
* Title Mr Mrs Ms Miss
* Full Name
* Address
* City
* Postal Code
* Phone
* Email
* Birth Date (mm/dd/yyyy)
* Age
* Canadian Citizen Yes No
* Government Sponsored Yes No
* Landed Immigrant Yes No
* Language: English Spoken Understood
* Language: Other Spoken Understood
Language: Require Interpreter Yes No
* Have you lived in G.E.F. building before? Yes No
If yes, where?
* Total income from Line 150 of last income tax return
* Please indicate tax return year
* Comprised of (check applicable box) Old Age Security (OAS) Guaranteed Income Supplement (GIS) Alberta Seniors Benefit (ASB) Assured Income for the Severely Handicapped (AISH) Canada Pension Plan (CPP) Other Income
If "Other Income", please specify
Title Mr Mrs Ms Miss
Full Name
Address
Postal Code
Phone
Email
Birth Date (mm/dd/yyyy)
Age
Canadian Citizen Yes No
Government Sponsored Yes No
Landed Immigrant Yes No
Language: English Spoken Understood
Language: Other Spoken Understood
Have you lived in G.E.F. building before? Yes No
Total income from Line 150 of last income tax return
Please indicate tax return year
Comprised of (check applicable box) Old Age Security (OAS) Guaranteed Income Supplement (GIS) Alberta Seniors Benefit (ASB) Assured Income for the Severely Handicapped (AISH) Canada Pension Plan (CPP) Other Income
* Alternate Contact: Name
* Alternate Contact: Relationship
* Alternate Contact: Home Phone
Alternate Contact: Business Phone
* Type of Accommodation Wanted Single Occupancy Double Occupancy Wheelchair Accessible
* Smoking? Yes No
* Location Preference: First Choice
* Location Preference: Second Choice
* When are you interested in moving?
* Home Owner: Yes No
If yes, check: Condo House/Duplex Other
* How long have you lived at your present address?
* Is your accommodation shared? Yes No
If you share your accommodation, are these relatives? Yes No
If yes, number of:
Adults:
Children:
Bedrooms:
Bathrooms:
What are your present monthly payments?
* Rent:
* Property Taxes:
* Heat:
* Light:
* Water:
Other:
* Most Recent Landlord
* Contact Name
* Phone Number
Property Management Company (if applicable)
* Have you ever been given a Notice to Vacate? Yes No
If yes, please fax a copy of notice to GEF:(780) 488-3561 or drop one off in person.
* Please type applicant's full name
Please type co-applicant's full name
* Date
Message
* Verify
Inquiries may be directed to the Central Office at 482-6561.
Your personal information is being requested under authority of the Alberta Housing Act and its regulations. Information that you provide to us will be used to determine eligibility for subsidized housing. Your personal information will be protected in compliance with The Freedom of Information & Protection of Privacy (FOIP) Act and its regulations. If you have any questions about the collection and use of this information, please contact the Information and Privacy Officer at 447-9207 or the site manager.
