BC Housing Rent Supplement Application Rent Supplement Information • THE RENT SUPPLEMENTS ARE FUNDED BY BC HOUSING AND ARE PROVIDED AS A FLEXIBLE, TIMELY OPTION FOR INDIVIDUALS AND FAMILIES WHO ARE EXPERIENCING HOMELESSNESS (OR AT RISK OF HOMELESSNESS) WHO DO NOT HAVE SUFFICIENT FUNDS TO EITHER FIND OR MAINTAIN APPROPRIATE HOUSING. • THE RENT SUPPLEMENTS ARE INTENDED TO PROVIDE A TOP UP TO RENT OR PROVIDE “BRIDGE” FUNDS THAT WILL HELP HOUSE PEOPLE QUICKLY (OR RESPOND PRIOR TO AN EVICTION). • EVERY EFFORT WILL BE MADE TO ENSURE TIMELINESS OF RESPONSE TO THIS PROCESS. Eligibility Criteria: • HOMELESS (ABSOLUTE OR RELATIVE) OR AT-RISK OF HOMELESSNESS • UNABLE TO ACCESS CRISIS FUNDING/GRANTS ELSEWHERE (I.E. MSD, I.A) • WILLINGNESS TO ACCESS SUPPORT FROM COMMUNITY AGENCY WHERE APPROPRIATE TO ADDRESS ANY OUTSTANDING BARRIERS TO FINDING AND MAINTAINING HOUSING There Are Two Types Of Supplements • ONE-TIME CRISIS • MONTHLY RENT Where To ApplyCRITERIA CONTACT NOW CANADA – HOUSING OUTREACH FEMALE, IDENTIFYING AS ONE OF THE FOLLOWING: • VICTIM OF VIOLENCE • LEAVING CORRECTIONAL SYSTEM • LEAVING HEALTH CARE SYSTEM • YOUTH AT RISK • ABORIGINAL 2970 TUTT ST, KELOWNA BC, V1Y 8Z5 PHONE: (250) 763-3876 FAX: (250) 868-3876 EMAIL: [email protected] MORE INFORMATION AND LINKS TO APPLICATIONS @ WWW.NOWCANADA.CA KI-LOW-NA FRIENDSHIP SOCIETY - OUTREACH • IDENTIFIES AS ABORIGINAL 442 LEON AVENUE, KELOWNA, BC, V1Y 6J3 PHONE: (250) 763-4905 FAX: (250) 861-5514 EMAIL: Please call for contact information FOUNDRY KELOWNA - OPERATED BY CMHA KELOWNA • YOUTH AT RISK (18-25) 504 SUTHERLAND AVE, KELOWNA BC, V1Y 5X1 PHONE: (250) 861-3644 FAX: (250)-763-4827 EMAIL: [email protected] CMHA KELOWNA - HOUSING & HOMELESSNESS SERVICES • 25+ 504 SUTHERLAND AVE, KELOWNA BC, V1Y 5X1 PHONE: (250) 861-3644 FAX: (250)-763-4827 EMAIL: [email protected] Application Process: Email Appropriate Agency for Application (And/Or Info) • COMPLETE RENT SUPPLEMENT APPLICATION • ATTACH PROOF OF RENT (LEASE AGREEMENT, RENT RECEIPT) AND MOST RECENT 60-DAYS BANK STATEMENT. IF NOT ATTACHED, IT WILL BE REQUESTED BY THE FACILITATOR AT A LATER DATE. • FAX COMPLETED FORM TO APPROPRIATE ORGANIZATION – CMHA, NOW CANADA, OR KFS • ORGANIZATION WILL FOLLOW-UP WITH REFERRAL SOURCE WITHIN ONE WEEK OF RECEIPT OF APPLICATION TO CONFIRM ELIGIBILITY AND APPROPRIATENESS OF APPLICATION Conditions of Application 1) IF CLIENTS’ RENT IS PAID DIRECTLY FROM THE MINISTRY OF SOCIAL DEVELOPMENT, REFERRING AGENCY IS RESPONSIBLE FOR ALL COMMUNICATION WITH MSD REGARDING ANY CHANGES IN STATUS OF CLIENT 2) RENT SUPPLEMENT CHEQUES WILL ONLY BE PAID DIRECTLY TO THE LANDLORD OR VENDOR AND A RECEIPT IS REQUIRED 3) THERE WILL BE A 6 & 12 MONTH FOLLOW-UP CALL 4) ALL RELEVANT INFORMATION IS RECORDED IN A DATABASE REPORTING ALL THE ACTIVITIES TO BC HOUSING 5) BC HOUSING CLIENT CONSENT AND AUTHORIZATION MUST BE SIGNED FOR RENTAL SUPPLEMENT CHEQUE TO BE RELEASED 6) INCOMPLETE APPLICATIONS MAY DELAY PROCESSING TIMES Verify SubmissionPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: Supplement RequestDate of Request *Referring Agent Organization Phone Number *Email * Client InformationLast Name *First & Middle Name *Phone Number Date of Birth *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweIs this a new tenancy? *YesNoTenancy Start Date *Monthly Rental Amount *Gender *MaleFemaleTransgender-FemaleTransgender-MaleOtherTwo-SpiritNon-binaryAboriginal *YesNoFamily Status *SingleCoupleFamily (If yes, please fill in next entry)Family Status- If family, please enter total number of individuals Monthly Income Amount Source of Income *NoneEMPLOYMENTEMPLOYMENT INSURANCE (EI)BASIC INCOME ASSISTANCE (IA)CANADA PENSION PLAN (CPP)CANADA PENSION PLAN – DISABILITY (CPP-D)OLD AGE SECURITY (OAS)GUARANTEED INCOME SUPPLEMENT (GIS)SAFERBCH RENTAL ASSISTANCE PROGRAM (RAP)CHILD TAX BENEFITINCOME ASSISTANCE - PERSONS WITH PERSISTANT MULTIPLE BARRIERS (PPMB)INCOME ASSISTANCE – PERSONS WITH DISABILTY (PWD)OTHER (If yes, please include more information in the field below):Source of Income: If OTHER, please provide details here Have you received any rent supplement funding before? *YesNoIf yes (previous question), from where? CMHA (Youth)KFSCMHA (Navigation)Now CanadaOther (If yes, please include more information in the field below):Source of previous rent supplement funding: If OTHER, please provide details here Previous rent supplement funding: On which date? Check Those That Apply For ClientSelect *IDENTIFIES AS ABORIGINALVICTIM OF VIOLENCELEAVING CORRECTIONAL SYSTEMLEAVING HEALTH CARE SYSTEMYOUTH AT RISKOTHER (If yes, please include more information in the field below)Check those that apply: If OTHER, please provide details here Type of Supplement RequestedSelect *ONE-TIME CRISISMONTHLY RENT SUPPLEMENT (CONSIDERATION FOR EXTENSIONS WILL BE DETERMINED UPON REVIEW) Please describe...The situation & need pertaining to rent supplement request: *How you plan to stabilize your housing situation after the supplement. Ex: Income assistance will be approved so I can pay the rent. *Has the client attempted to access funds elsewhere? Please explain: * Landlord/ Billing InformationLast Name *First & Middle Name *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabwePhone Rental Name (Hotel/ Building) *Rental Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweDescription of Rental *APARTMENT IN MARKET HOUSINGHOTEL/ ROOMING HOUSEROOM IN A HOUSESECONDARY SUITERECOVERY/TREATMENTCAMPSITESOCIAL HOUSING/SUPPORTED HOUSINGOTHER (If yes, please include more information in the field below)Description of Rental: If OTHER, please provide details here Other Supports InvolvedProbation/ Parole Mental Health Support Alcohol & Drug Support Family Physician Psychiatrist Other Client Consent & AuthorizationService provider name *. is seeking your consent for the following purposes: Your consent to collect your personal information into the computer system we use. • This will help us meet your needs and connect you with appropriate support services. Your consent to share your personal information with our funder, BC Housing. • BC Housing is responsible for hosting the computer system we use to help manage our services. • BC Housing will use the information in the system, at an aggregate level, to help improve services and funding. Your consent to migrate your personal information from the current computer system we use to the new one we will be using in the future. Your consent to share your personal information with other service providers using the system. • The new computer system we will be using in the future will allow for some data sharing. • If you require services from another service provider, authorized staff will be able to access your personal information to improve the consistency and quality of services provided to you. If you are accompanied by your children who are under the age of 19, we will also need to collect personal information about them. This is to ensure that information about families using services is recorded accurately. Your consent to share limited non-identifying information with Employment and Social Development Canada. • They will use this data to help create a national picture of the scope of homelessness in Canada. If you choose not to sign this document, services will still be provided to you, except in regard to rent supplements. If your service provider has rent supplements, you will need to sign this consent form to be considered for and to receive a rent supplement (for accounting purposes). Digital SignatureSignature of Client to Indicate Consent *I consent to the release of this informationName of Client *Date of Consent * Attach Documents Please attach any supporting documents. Acceptable file types for upload: .png, .jpg, .pdf, .doc, .docx, .xlsFile Upload Verify SubmissionPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: