NIPISSING DISTRICT HOUSING REGISTRY INC.

Transcription

1 NIPISSING DISTRICT HOUSING REGISTRY INC. Market Rent Application For the District of Nipissing For office use only Date Received: Received By: 1. Instructions Please fill out all sections of the form. Please print clearly, in ink. Return the form to: Nipissing District Housing Registry 92B Lakeshore Drive Phone: North Bay, Ontario Fax: P1A 2A6 Or drop off at a participating Housing Provider (see pages 4, 5 and 6) 2. Applicant Contact Information Last Name: Street Number & Name Post Office Box Other person to contact Spoken Language(s) English French Other Household Information First Name: Apt. No. City Province Postal Code Home Telephone Work/Daytime Telephone ( ) ( )* Telephone: ( ) Preferred language for correspondence English French Other Household Information Applicant: Co- Applicant: Co-Applicant: Co-Applicant: Co-Applicant: Mailing Address (if different than above): *Calls to offer housing are made during office hours. Please ensure that you can be reached during the day. Page 1 of 6 July 2011

2 Do you own a vehicle? Yes No Do you require parking? Yes No Do you or any member of your household have special housing needs due to a serious health reason or disability? Yes No Do you or any member of your household require? Wheelchair Accessible Unit No Carpeting No Stairs Describe any specific requirements: Other 3. Current Landlord Information Name: Street Address: Apartment Number: City: Province: Postal Code: Telephone Number: Date Moved in: Page 2 of 6 July 2011

3 4. Declaration and Consent I/We declare that all information given in this application is correct and complete. I agree that the application and any supporting documents become the property of the Nipissing District Housing Registry Inc. and copies of the application and supporting documents may be given to housing providers that I have selected for placement in locations where I prefer to live. I/We agree to provide any supporting material as may be required. I/We understand and agree that if accommodation is provided to me, the unit will be occupied by me and the persons listed on this application. Pursuant to the Provincial/Municipal Freedom of Information and Protection of Privacy Act, I/we give our consent: To verify information given in this application and I/we authorize any person, corporation or any social agency having knowledge of any such required information to release the information to the Nipissing District Housing Registry Inc. To verify any supporting documents as required for my application Personal information contained in this form or in attachments is collected by the Nipissing District Housing Registry Inc. 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) and Personal Information & Protection of Electronic Documents Act. Questions about this collection should be directed to the Housing Coordinator of the Nipissing District Housing Registry Inc., North Bay, Ontario P1A 2A6. I/we understand that if I owe money to any social housing provider, covered under the Housing Services Act 2011, in the province and I/we have not made arrangements for repayment, I/we may not be eligible for housing. I/we understand that this application is not an agreement on the part of The Nipissing District Housing Registry Inc. or its agent to provide me with rental accommodation. X Applicant s signature X Co-Applicant Signature Date Date Page 3 of 6 July 2011

4 5. CITY OF NORTH BAY (Market Rent units) PLEASE CIRCLE THE SIZE OF UNIT YOU ARE APPLYING FOR DOWNTOWN Nipissing District Housing Corporation Bliss Gilmor Main Street 1 and 2 Bedroom Apartments Shibelith Group Incorporated 1618 Wyld Street 3 Bedroom Single House FERRIS Holy Name Community Non-Profit Housing Corporation Trillium Terrace - 70 Marshall Avenue East Trillium Terrace - Mulligan Street 1 and 2 Bedroom Apartments Barrier Free: 2 Bedroom Apartments 3 Bedroom Townhouses Nipissing District Housing Corporation (Phase II) Birchcrest -Thelma Avenue Physically Handicapped Adults Rehabilitation Association Westwinds Village 122 Massey Drive 1, 2 & 3 Bedroom Row Housing Shibelith Group Incorporated Spectrum Condo #3-850 Lakeshore Drive 3 Bedroom Townhouses 14 Prince Edward Drive 3 Bedroom Single Home Highbury Park 8 David Street 3 Bedroom Single Home 18 and 30 Karla Drive 3 Bedroom Single Home 5 and 11 Ryan Avenue 3 Bedroom Semi-detached Gladstone 47 Gladstone Avenue 3 Bedroom Single Home Anne Marie Meadows 866 Lakeshore Drive McKEOWN Nipissing District Housing Corporation (Phase I & II) Maplecrest I McNamara Street Maplecrest II McNamara Street 2 and 3 Bedroom Stacked Townhouses Page 4 of 6 July 2011

5 PINEWOOD Physically Handicapped Adults Rehabilitation Association Westwinds Apartments Oakwood Avenue Westwinds Heights Oakwood Avenue 2 and 3 Bedroom Apartments 1 and 2 Bedroom Townhouses Shibelith Group Incorporated Nipissing Condo # Gormanville Road 3 Bedroom Semi-Detached 587 Gormanville Road 3 Bedroom Semi-Detached 593 Gormanville Road 3 Bedroom Semi-Detached Gormanville Road 3 Bedroom Semi-Detached Gormanville Road 3 Bedroom Semi-Detached SCOLLARD Castle Arms Non-profit Senior Apartments Housing Corp. Castle Arms I, II, III - 440, 480, 520 Olive Street Castle Arms IV 350 Olive Street (Smoke Free Building) Seniors Only(Age 65 Accepted): 1& 2 Bedroom Apartments Seniors Only(Age 65 Accepted): 1 Bedroom Apartments Barrier Free: 5-1 bedroom units SKI CLUB ROAD Nipissing District Housing Corporation (Phase II) Cedarcrest Carruthers Street 6. Housing Providers Surrounding North Bay (Market Rent units) The following housing providers are located in towns outside of the City of North Bay. MATTAWA Castle Arms Non Profit Seniors Apartments Housing Corp. Castle Arms Mattawa 940 McKenzie St. (Smoke-Free Building) Seniors only (Age 65 Accepted): 1 and 2 Bedroom Units Barrier Free: 2-1 Bedroom Units Page 5 of 6 July 2011

6 STURGEON FALLS West Nipissing Non-Profit Housing Corporation Villa du Loisir Michaud Street Villa des Pignons Coursol Road Domaine Leclair Coursol Road Résidences Mutuelles (Legion 225) Inc Résidence II 140 Parker Street Barrier Free: 2 Bedroom Apartments TEMAGAMI Temagami Non-profit Housing Corporation Minawassi 11 Bayview Lane Ronnoco House 5 Bayview Lane 1, 2 and 3 Bedroom Apartments Barrier Free: 1 Bedroom Apartments Emergency Housing/Services North Bay Crisis Centre Emergency Line Halfway House Ojibway Family Resource Centre Nipissing Transition House Sturgeon Falls Family Resource Centre Mattawa Family Resource Centre Page 6 of 6 July 2011