Application for Page 1 of 7 Subsidized Housing

HOW TO FILL OUT THE LANARK COUNTY APPLICATION FOR SUBSIDIZED HOUSING – FREQUENTLY ASKED QUESTIONS (more information can be found on our website at www.lanarkcounty.ca )

HOW DO I QUALIFY FOR SUBSIDIZED HOUISNG? WHO CAN APPLY?  At least one member of the household must be 16 years of age or older and able to live independently.  Each member of the household must be a Canadian citizen, a landed immigrant, or have Refugee Claimant Status, with no outstanding deportation, departure or exclusion order in effect to leave .  If you owe money to any federally, provincially or municipally funded housing provider, you must pay the money owed or have an active repayment agreement in place which is in good standing.  No member of the household has been convicted of misrepresenting their income to receive rent-geared-to-income assistance by the Landlord and Tenant Board or a court of law in the past two years.  Many of our Housing Providers require Tenant Insurance to be eligible. If you do not already have content and liability insurance you can access low-cost insurance by applying for HSC Tenant Insurance Program by calling 1-866-940-5111

HOW DO I KNOW IF I WAS ADDED TO THE WAITLIST?  Lanark County Social Housing will respond to all applications in writing within 21 days of receiving them. If you have not heard from us after 21 days, please contact us to ensure we have received your application. Your placement on the waitlist is based on when our office receives your application, so it is important that we get it as soon as possible.  INCOMPLETE APPLICATIONS WILL NOT BE ADDED TO WAITLIST. Incomplete applications will be returned to the mailing address provided in the application. Applications will not be accepted and added to the waitlist until all required information is provided. The waitlist is in chronological order based on the date that complete applications are received, so it is important that you complete all sections of the application and provide all required documents at the earliest date possible.

WHEN WILL I BE HOUSED?  We cannot predict wait times as there is no way to predict when units will become available in the buildings you have requested. Due to a high demand for subsidized housing, average wait times in Lanark County are between 3-5 years.

WHERE DO I SUBMIT MY APPLICATION? Lanark County Tayside Community Lanark County Social Housing Clayton Seniors’ Housing Corporation Residential & Support 99 Christie Lake Road Housing Corporation 52 Abbot Street North Options Perth, ON K7H 3C6 134 Linn Bower Lane, Unit 4 P.O. Box 707, 613-267-4200 ext. 2402 RR#3 , ON 100 Wilson Street East Fax: 613-267-3620 Clayton, ON K0A 1P0 K7A 1W3 Perth, ON K7H 3K5 [email protected] 613-256-6769 613-283-2555 613-264-0953 Municipal Non-Profit Tay Valley Non-Profit The Five Arches Non- Mills Community Support Housing Corporation Housing Corporation Profit Housing Provider Corporation Elizabeth Court Tay Gardens 178 Five Arches Drive 67 Industrial Drive 105 Elizabeth Street 20 Haggart Street P.O. Box 249 Almonte, ON K0A 1A0 Carleton Place, ON K7C 2V9 Perth, ON K7H 2Z4 Pakenham, ON K0A 2X0 613-256-1031 613-257-4812 613-264-1997 613-624-5619

 You may submit a request for review if you do not agree with a decision made by any Lanark County Social Housing Provider. Requests must be made in writing. For questions on how to submit an appeal please call 613-267-4200 (toll free 1-888-952-6275) ext. 2401. Please send all appeals to Sandy Grey- Lanark County Social housing Manager, 99 Christie Lake Road, Perth, On K7H 3C6

Application for Page 2 of 7 Subsidized Housing

APPLICANT INFORMATION First Name: Last Name: Middle Name: Social Insurance # (optional): Gender:

Male Maiden / Alternate Last Name: Birthdate (MM/DD/YY) Female

Status in Canada (If you are not a Canadian Citizen please attach documents) Birth Certificate Provided Canadian Citizen Landed Immigrant Refugee Claimant Apt #: Street Address: City: Postal Code:

PO Box: Mailing Address (if different):

Email:  Do not provide us with a number where you are not able to accept calls.  We will not be able to send or accept text messages.  It is your responsibility to update us when a phone number or address changes. Home Phone : If we can’t contact you we can’t offer you a housing unit! Call 613-267-4200 ext.

2402 to update your file.

 Please be sure to provide us with at least one alternative contact. The perfect Cell Phone: alternative contact is someone whose phone number will not change and who will be able to get in touch with you immediately. Work Phone: Have you, or any member of your household, been found under the Criminal Code (Canada), Landlord and Tenant Board or court of law to have misrepresented income while living in social housing within the last two years? Yes No Alternative Contact Name: Contact Phone #: Relationship:

CO-APPLICANT INFORMATION First Name: Last Name: Middle Name: Social Insurance # (optional): Gender:

Male Maiden / Alternate Last Name: Birthdate (MM/DD/YY) Female

Status in Canada (If you are not a Canadian Citizen please attach documents) Birth Certificate Provided Canadian Citizen Landed Immigrant Refugee Claimant Apt #: Street Address: City: Postal Code:

PO Box: Mailing Address (if different):

DEPENDENTS (please attach additional sheet if more space is required) First Name Last Name Gender Relationship to Applicant Birth Date Birth Certificate MM/DD/YY Provided

Application for Page 3 of 7 Subsidized Housing

Have you or any member of your household previously lived in social housing in the province of ? Yes No If yes please complete below section.

1. Housing Provider Name and Address From (date) To (date)

Resident Name on Lease or Occupancy Agreement Rental or Damage Arrears Outstanding $

Eligibility for the Social Housing Registry requires any monies owed to any social housing provider in Ontario be paid in full or have an active payment agreement in place. If you are requesting Special Priority Status or feel your circumstances warrant special consideration, please contact our office regarding arrears. Do any members of the household owe money (i.e. unpaid rent or damages), to any social housing provider in Ontario? Yes No If YES please attach a copy of approved re-payment agreement

INCOME Must be completed by all household members with income, please include additional page if required The Lanark County Housing Providers follow maximum household income limits to determine eligibility for rent-geared-to-income assistance which are preset by the Housing Services Act, 2011. No rent-geared-to-income unit will be offered to a household with total household income greater than the maximum household income limit for the applicable unit size.

Definition of Income - Income includes money of every kind and source including full time, part time or temporary employment (gross salary, overtime payments, commissions), personal salary or benefits of self-employment, pension income from any public or private source, income from any government source (Employment Insurance, Worker's Compensation, Ontario Works), annuities, inheritance, alimony/support payments, interest from saving accounts, investments and term deposits, grants, scholarships, etc. If no income received indicate “NIL”. Source of Income Applicant Co-Applicant (Please specify i.e. Employment/OW/CPP) Gross Monthly Gross Monthly $ $ $ $ $ $ Total: $ $

ASSETS Must be completed by all household members with assets, please include additional page if required The Lanark County Housing Providers follow maximum household asset limit, of $ 100 000, to determine eligibility for rent-geared-to- income assistance which is determined by Lanark County Social Housing Policy /2012-05: Household Asset Limits. No rent-geared-to- income unit will be offered to a household with a liquid asset limit in excess of the maximum Household Asset Limit.

Definition of Assets - Assets are valuable things that you own. Income producing assets are investments such as bank accounts, real estate which you rent out, a business etc. which provides you with an income. Non-income producing assets include life insurance, property not rented out, Registered Retirement Savings Plans. Asset Type Value Income Producing (Please specify i.e. Savings, RRSP) $ Yes No $ Yes No $ Yes No $ Yes No

It is important that you provide us will accurate information. When you are offered a unit you will be required to provide proof of all household income and assets. If you do not meet income and asset requirements, the offer will be withdrawn and your application will be removed from the waitlist.

Application for Page 4 of 7 Subsidized Housing

HOUSING REQUIREMENTS Are all Household Members currently residing at the same address? Yes No If NO please provide documentation to explain separation (i.e. custody arrangements, CAS orders).

Is any household member expecting a baby? Yes No If YES please provide expected due date :______

Some units are not inclusive of utilities. Can utilities (i.e. Hydro/ Enbridge) be put in a household member’s name? Yes No If NO do not select any units that require utilities to be put in tenant’s name.

Do you require a ground floor unit for medical reasons? Yes No If YES please submit medical verification. Please not that requiring a ground floor unit may increase wait times.

Do you require an accessible unit for medical reasons? Yes No If YES please submit medical verification. Please note that requiring a ground floor unit may increase wait times.

Do you intend to complete a request for Special Priority Status? Yes No If YES, please contact us or Interval House at 1-800-267-7946 or e-mail us at [email protected] for a Special Priority Application.

Do you own property that is suitable for year round occupation? Yes No If YES please submit a letter of opinion from a qualified professional (i.e. Real estate Agent) as to the value of your property. If you are offered accommodations you must agree to sell your property at fair market value within six months.

Do you have rental insurance? Yes No Many units require tenant insurance to be eligible for a unit. If you do not already have content and liability insurance you can access low-cost insurance by applying for HSC Tenant Insurance Program by calling 1-866-940-5111.

Unit Size Required: The size of the unit (number of bedrooms) is limited by eligibility requirements and occupancy standards for rent-geared- to-income assistance (one bedroom per person/ couple). Notify the Social Housing Registry of special circumstances (medical situations, custody or visitation agreements) that may impact on unit size and attach supporting documentation.

Bachelor 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom

GENERAL INFORMATION 1. You are entitled to 3 offers for housing. If all offers are refused your application will be cancelled. Failure to respond to an offer will count as a refusal. Failure to keep us up to date with contact information, leading to our inability to contact you, will count as a refusal. Failure to obtain content and liability insurance will count as a refusal if the housing provider you select requires it. 2. If you accept an offer for housing, you will be removed from the waitlist. You will be required to reapply if you wish to receive offers for other units in the future. 3. The information you have provided to us is used to determine your eligibility to be on the waitlist. You will be required to provide further verification to the housing provider upon accepting a unit. If upon providing verification the provider determines you are not eligible for Rent-Geared-to-Income housing you will not be offered the unit and will be removed from the waitlist.

BUILDING INFORMATION LEGEND Tenant is responsible for their own Hydro. Tenant is responsible for their own Heat. Hydro Account must be put in their name. Heat Account must be put in their name. Non-Smoking Building No Pets Allowed

Mandatory Tenant Insurance. Tenant is required to have Fridge and Stove is not included content and liability insurance. LCHC Lanark County Housing Corporation MCSC Mills Community Support Corporation Tayside Community TCO PAK The Five Arches Non-Profit Housing Provider Residential & Support Options Rent Supplement Building Selection. The Rent Supplement Program provides units to applicants through Private special agreements with qualified private sector landlords. Application for Page 5 of 7 Subsidized Housing

HOUSING SELECTION

Please select all units you wish to be added to your housing choices. Please only select unit sizes that you are eligible for, as per Lanark County Occupancy Standard. Only those that you select, and that you are eligible for will be offered to you in the future. Housing Selection can be updated at any time by contacting Lanark County Social Housing 613-267-4200 ext. 2402.

Legend Type of Municipality/Location Units Available 1 2 3 4 5 Provider Bachelor Bedroom Bedroom Bedroom Bedroom Bedroom Almonte LCHC 176 Robert Street

LCHC Victoria/ St. James Street

MCSC 278-282 Maude Street

MCSC 321-334 Maude St./ St. James St

MCSC 107-144 Norton Street

Private 326 Maude Street Carleton Place

LCHC 126 Sussex Street

LCHC 252 Moffatt Street

LCHC 171 Munro Street LCHC 112-143 Caldwell Street

LCHC 144-180 Caldwell Street

LCHC Joseph/ Edward/ Pattie

LCHC 404-406 Pattie Drive

LCHC 179 Caldwell/ Arthur Street

Private 24 Townline Road

Private 270 Bridge Street Private 266 Bridge Street

Private 326 Bridge Street Perth LCHC 75 Harvey Street

LCHC 77 Harvey Street

LCHC 16 Herriott Street

LCHC Beckwith/ Robinson Street

LCHC 10 Welland Street

LCHC 4 Railway Street

TCO 31 Rogers Road Private 18 Haggart Street

Private 27 Cockburn Street 1830 Rogers Road Private *(Referral Required) Application for Page 6 of 7 Subsidized Housing

Smiths Falls LCHC 46 Bell Avenue

LCHC 195 Carss Avenue

LCHC 30 McGill Street South

LCHC 24 Bourke Street

LCHC Sussex/ Empress

LCHC 3A & 3B Anne/9A & 9B Lanark St

LCHC 68 Broadview Avenue

LCHC 72 Thurber Street

LCHC Jasper/ Beech/ Carss

LCHC Parkland Court

Private 28 Church Street

Private 31 Main Street West

Private 46 Street

Private 12 Toulon Street

Private 7 Main Street West

Private 54 Broadview Avenue

Private 22-28 Toulon Place

Private 41 Marsha Drive

Private 12 Chambers Street

Private 22 Toulon Street

Private 28 Toulon Street Pakenham PAK 178 Five Arches Drive SENIORS HOUSING Seniors Housing Providers accept only applicants who are at least 65 years of age. If a couple is applying for Seniors Housing, both applicants must be 65 years of age, or older. Municipality Provider Units Available 1 Bedroom 2 Bedroom Perth Tay Valley Non-Profit Housing 20 Haggart Street Corporation (Tay Garden)

Carleton Place Carleton Place Municipal Non-Profit

105 Elizabeth Street Housing Corporation (Elizabeth Court) Almonte Mills Community 375 Country Street Support Corporation

411 Country Street Clayton Clayton Seniors Housing Corporation

134 Linn Bower Lane (Linn Bower Apartments) Perth Ashley Chase Apartments 99 Harvey Street

**If you require an accessible unit please indicate so in Housing Requirements section on Page 4** Application for Page 7 of 7 Subsidized Housing

Declaration and Consent to Collect, Use and Disclose of Personal Information I/we the undersigned declare, consent to, and understand the following: 1) That all information given in this application is correct and complete, and will supply supporting material that may be required. 2) That the information that is provided in this application will belong to the Social Housing Registry and that the information will be given to the housing providers selected in this Application. 3) If something on this application is incorrect or not true, the Social Housing Registry or the housing providers selected in this application may request additional information, may cancel this application or both, and I/we may be prohibited from re-applying for rent-geared-to- income assistance for a minimum period of two years under the Housing Services Act, 2011. 4) That only the individuals included on this application form may live with me/us in social housing.

5) That the Social Housing Registry or housing providers selected will use the information provided to determine initial and continued eligibility for social housing and/or rent-geared-to-income assistance, and to determine how much assistance for which I/we are eligible. 6) All members of the household are in Canada legally. 7) That any money owed to any social housing provider in Ontario must be repaid, or have a payment agreement in place with regular payments being made, before this application can be placed on the Social Housing Registry or the wait list for a provider selected. 8) That any changes to this information must be reported to the Social Housing Registry. 9) That this application must be updated each year with the Social Housing Registry, and that the Registry will provide an Update/Change of Information form to be completed and returned. It is the applicant’s responsibility to update and return the completed form. 10) That any information provided in this form and any attachment may be verified, and I/we authorize any person, corporation or any social agency having knowledge of any information to release that information to the Social Housing Registry and/or other Social Housing Provider within Lanark County for the purpose of verifying initial or ongoing eligibility for social housing. 11) I give my permission for Lanark County to exchange electronic data via email agency, person, business or organization and exchange information regarding this request. Further, I/we understand that there are laws that allow personal information to be collected or shared with others, and that any information on this form and any attachment which is given to a body listed herein is confidential and will only be given in accordance with the Housing Services Act, 2011 and associated regulations. Specifically, I/we allow the information on this Application and any attachment to be given, without further notice, to: 1) Social services offices, other municipal service managers or district social services administration boards and housing providers, if the information is necessary for the purpose of making decisions or verifying eligibility for assistance under the Housing Services Act, 2011, the Ontario Works Act 1997, the Ontario Disability Support Program Act 1997, or the Day Nurseries Act. 2) The government of Canada, a department, ministry, or agency of it, if the information is necessary for the purpose of administering or enforcing the Income Tax Act (Canada) or the Immigration Act. 3) Any government or body with whom an agreement has been made under the Housing Services Act, 2011, for the purpose of conducting research, reporting and policy purposed related to a social benefit program or social housing or rent-geared-to- income assistance program. Personal information contained in this form or in attachments is collected by The Registry pursuant to the Freedom of Information and Protection of Privacy Act (R.S.O. 1990 c. F.31) or the Municipal Freedom of Information and Protection of Privacy Act (R.S.O. 1990 c.M.56). This information may be used to determine eligibility for housing applied to, continuation of housing and may be used for the appropriate rent-geared-to income charge.

Signatures of Household Members This Application and Declaration and Consent must be signed by the applicant and all non-dependent members of the household. Applicant Household Member Household Member Household Member

Household Member Date (month, day, year)