SAULT STE. MARIE SOCIAL HOUSING APPLICATION CENTRE APPLICATION PACKAGE DISPONIBLE EN FRANÇAIS

l SAULT STE. MARIE SOCIAL HOUSING APPLICATION CENTRE APPLICATION PACKAGE DISPONIBLE EN FRANÇAIS It is the mission of the Sault Ste. Marie Social Housing Application Centre to ensure that people have equal opportunity and ease of access to the waiting lists of all members of Sault Ste. Marie Social Housing Application Centre. Members consist of Local Non-Profits, Co-Ops and the Sault Ste. Marie Housing Corporation. Complete all sections of the attached application form. Please print all information in ink. ELIGIBILITY REQUIREMENTS FOR RENT-GEARED-TO-INCOME (RGI): [O. Reg. 367/11 s. 24 - s. 32] At least one member of the household is 16 years of age or older and is able to live independently with or without support services. Each member of the household must be a Canadian Citizen, has made application for status as a permanent resident or has made a claim for refugee protection under the Immigration and Refugee Protection Act (Canada). No removal order has become enforceable against any member of the household.. No member of the household owes arrears of rent or money owed as a result of damage they caused with respect to any previous tenancy in any housing project under any transferred housing program. The Sault Ste. Marie Social Housing Application Centre may not require payment if it is satisfied that there are extenuating circumstances or a suitable agreement to repay the housing provider has been arranged. No member of the household has been convicted of an offence under Section 36 of the Housing Services Act, 2011 or a crime under the Criminal Code (Canada) in relation to the receipt of rent-geared-to-income assistance, or found by the Landlord and Tenant Board (formerly known as the Ontario Rental Housing Tribunal) or convicted of an offence of misrepresentation of income for the purpose of Rent-Geared-To- Income. All RGI tenants will be required to pursue all possible sources of income, that they may be eligible for, including Ontario Works, Child Support, Employment Insurance and Immigration Sponsorship Support. A household that owns residential property that is suitable for year-round occupancy, whether the property is in or outside of Ontario, must sell the property within 180 days after receipt of rent-geared-to-income subsidy. (May be subject to review on a case-by-case basis). The household s Gross Household Income is less than or equal to the Service Manager s Household Income Limit amount applicable to the size and type of unit. If your income is greater than the Service Manager s Household Income Limit amount, you can apply directly to the Non-Profits and Co-operatives for market rent units. Applicants and Tenants who knowingly misrepresent their income will be ineligible for RGI subsidy, and will be subject to fines or imprisonment. A Senior, for the purpose of this application, is any person 60 years of age or older, or will be 60 years of age within 12 months of date of application To submit your application and for questions or status contact: SAULT STE. MARIE SOCIAL HOUSING APPLICATION CENTRE 180 Brock Street, Sault Ste. Marie ON, P6A 3B7 Phone: 705-759-7748 RVD NOV. 2015

DEFINITION: SPECIAL PRIORITY HOUSEHOLD CATEGORY A household that the Service Manager has determined eligible to be included in the Special Priority category on the waiting list is a household where: [O. Reg. 367/11,s.54 and s.56] A member of the household has been subject to abuse from another individual: Spouse, parent, child or other relative A person who is sponsoring the individual as an immigrant A person on whom the individual is emotionally, physically or financially dependent The abusing individual is or was living with the household member A letter requesting Special Priority status must be prepared by the applicant in writing and must state: That a household member has been subject to abuse That the household member intends to live permanently apart from the abuser Only one of these individuals listed below is required and acceptable to verify Special Priority status [O. Reg. 367/11 s.58.(5) 1-9]: A Doctor A Lawyer A Law Enforcement Officer A Teacher A Guidance Counsellor A Community Healthcare Worker An individual in a managerial or A Community Legal Worker administrative position with a A Social Services Worker/Shelter Worker/Social Worker/Victim housing provider Services Worker/Settlement Services Worker A member of the Clergy A person familiar with the abuse. A signed declaration of truth A Registered Nurse, Registered administered by a Commissioner for taking affidavits must Practical Nurse accompany written record. The verification must contain a statement of one of the following in writing [O.Reg. 367/11, s.58. (2) 1-8]: A record of intervention by the police indicating that the member was abused by the abusing individual A record of physical injury caused to the member by the abusing individual A record of the application of force by the abusing individual against the member to force the member to engage in sexual activity against his or her will A record of undue or unwarranted control by the abusing individual over the member s personal or financial activities A record of one or more incidents of stalking or harassing behaviour against the member or another member of the household A record of one or more incidents of abuse including the following: Destroying or injuring or threatening to destroy or Threatening to physically harm the member or injure the member s property another member of the household Threatening to harm or remove the member s Threatening to prevent the member from having children from the household access to his or her children Forcing the member to perform degrading or Threatening to use a weapon against member or humiliating acts another member of the household Words or actions that threaten an individual to fear Threatening to take action that might lead to the for his/her safety member being deported Threatening to take action to withdraw from Other words, actions or gestures, which leads the sponsoring the member as an immigrant member to fear for his or her safety Failing to provide or withholding the necessities of Terrorizing the member life Intentionally killing or injuring pets or threatening Threatening to kill the member or another member to kill or injure pets of household Enforcing social isolation upon the member The Request for Special Priority status must be submitted within three-months after the abused ceases to live with the abuser or the abused is currently fleeing an abusive situation [O.Reg. 367/11,s.54 2(1)] 2

Special Priority (This pertains to any member listed on the application) Are you applying for Special Priority Status: YES NO I am applying for Special Priority status because I or someone in my household is currently a victim of abuse Name of Abuser: I have lived apart from the abuser for less than 3 months If you checked above, please specify date moved out: I am currently RESIDING WITH abuser Do you believe that you are at risk of being abused if you attempt to obtain information or documents to support your request for housing? If yes, please give explanation: ** ONCE HOUSED, YOU MUST PROVIDE VERIFICATION OF YOUR HOUSEHOLD INCOME** FOR OFFICE USE ONLY RANKING DATE FOR SPP ON WAITLIST: APPROVED NOT APPROVED REASON: INTERNAL REVIEW DUE: APPROVED DENIED Client Service Co-Ordinator: Agency Confirmed by: 3

Instructions for Making an Application to the SSM Social Housing Application Centre If you are applying for Special Needs/Modified Housing, you must complete the entire application including Section 7. Verification of all income and assets will be required before an application can be processed including realtor appraisals of unsold properties; proof of reasonable efforts to sell property will be required upon acceptance for rent-geared-to-income assistance. If you are receiving Ontario Works or Ontario Disability Support Program, a copy of your drug or dental card and cheque stub will also be required. For Part-time custody, legal verification or a Notarized/Commissioned document is required verifying you having overnight custody. A Co-Applicant is any household member 16 years of age or older. When your application is received, it will be reviewed to ensure it is complete. You will receive written notification stating whether or not your application is complete; reasons will be listed if incomplete. You will be given 10 days to respond to an incomplete notice, failing which your application will be cancelled & shredded. It is very important that you can be contacted at the phone number(s) you have provided. Any changes to your application ( income, address, telephone number, etc.) must be reported to the Social Housing Application Centre within 30 days after the change. [O. Reg. 367/11 s.28. (1-7)]. Failure to notify the Social Housing Application Centre may result in the cancellation of your application. You must state all sources of income of those in your household and provide proof of each, including last year s income tax return (if previous years taxes have not been filed, verification is required from the Canada Revenue Agency). If you self-identify as anyone of these Aboriginal designations: First Nation Status First Nation Non-Status Metis Inuit You are eligible to apply for subsidized housing through the Ontario Aboriginal Housing Services. Applications are available at the Sault Ste. Marie Social Housing Application Centre, 180 Brock Street, Sault Ste. Marie, Ontario P6A 3B7 as well as the Ontario Aboriginal Housing Services office located at 500 Bay Street, Sault Ste. Marie, Ontario P6A 1X5. Initial Eligibility Requirements: Do you owe any money to any housing provider? Yes No If so, name of housing provider and the amount: Are you receiving Social Assistance: Yes No If yes - Ontario Works Ontario Disability Support Program Yes Yes 4

SECTION 1 APPLICANT Ontario Coordinated Access Housing Application Primary Details Salutation Mr. Mrs. Ms. Last Name First Name Middle Name Maiden Name Marital Status Single Divorced Common Law Married Widowed Other Date of Birth (MM/DD/YYYY) Sex Male Female Social Insurance Number (SIN) Status in Canada Canadian Citizen Landed Immigrant Deportation Order Street No. Name Apt. No. Province Refugee Other Specify if other: Mailing Address Postal Code Sponsored Immigrant Telephone Numbers Home Work Can you take personal calls? Can we safely contact you at this address and phone number? Yes No If No, where can we contact you? Special Notes E-Mail Address Preferred mode of communication Mail E-Mail Phone Persons to contact in your absence or to act as an interpreter Name Relationship Telephone Number YOUR PRESENT ACCOMMODATION: Home Information Own Rent Temporary Co-Own NOTE: If you own a home you must have an estimated value from a real-estate appraisal or tax bill. 5

Section 2 Co-Applicant Note: Include only those co-applicants who will be living with you. Primary Details Salutation Mr. Mrs. Ms. Last Name First Name Middle Name Maiden Name Marital Status Single Divorced Common Law Married Widowed Other Date of Birth (MM/DD/YYYY) Sex Male Female Social Insurance Number (SIN) Status in Canada Canadian Citizen Refugee Other Landed Immigrant Relationship to Applicant Deportation Order Specify if other Sponsored Immigrant Street No. Name Apt. No. Province Mailing Address Leave blank if same as Applicant Postal Code Telephone Numbers Leave blank if same as Applicant Home Work Can you take personal calls? Can we safely contact you at this address and phone number? Yes No If No, where can we contact you? Special Notes E-Mail Address Preferred mode of communication Mail E-Mail Phone YOUR PRESENT ACCOMMODATION: Home Information Own Rent Temporary Co-Own NOTE: If you own a home you must have an estimated value from a real-estate appraisal or tax bill. 6

1. Relationship to applicant: Section 3 Other Members Please include any additional Household Member(s) Friend Child Parent Grandparent Other Relative Other Last Name First Name Middle Initial Sex Male Female Date of Birth (MM/DD/YYYY) Social Insurance Number (SIN) Student Disabled Senior Grandchild 2. Child Parent Grandparent Relationship to Friend Other Relative Other Grandchild applicant Last Name First Name Middle Initial Sex Male Female Date of Birth (MM/DD/YYYY) Social Insurance Number (SIN) Student Disabled Senior 3. Child Parent Grandparent Relationship to applicant Friend Other Relative Other Grandchild Last Name First Name Middle Initial Sex Male Female Date of Birth (MM/DD/YYYY) Social Insurance Number (SIN) Student Disabled Senior 7

4. Child Parent Grandparent Relationship to applicant Friend Other Relative Other Grandchild Last Name First Name Middle Initial Sex Male Female Date of Birth (MM/DD/YYYY) Social Insurance Number (SIN) Student Disabled Senior Section 4 Previous Tenancy Please specify any previous tenancies in Subsidized Rental accommodation in Ontario. Tenant Name Address Line 1 Address Line 2 Province, Postal Code Occupancy From (MM/DD) Occupancy To (MM/DD) Landlord Name Landlord Address (Street&Apt) Province, Postal Code Landlord Phone No. Subsidized? Arrears? Tenant Name Address Line 1 Address Line 2 Province, Postal Code Occupancy From (MM/DD) Occupancy To (MM/DD) Landlord Name Landlord Address (Street&Apt) Province, Postal Code Landlord Phone No. Subsidized? Arrears? Tenant Name Address Line 1 Address Line 2 Province, Postal Code Occupancy From (MM/DD) Occupancy To (MM/DD) Landlord Name Landlord Address (Street&Apt) Province, Postal Code Landlord Phone No. Subsidized? Arrears? Tenant Name Address Line 1 Address Line 2 Province, Postal Code Occupancy From (MM/DD) Occupancy To (MM/DD) Landlord Name Landlord Address (Street&Apt) Province, Postal Code Landlord Phone No. Subsidized? Arrears? 8

DEFINITION OF INCOME Income means the total amount of all payments of any nature paid to or on behalf of or for the benefit of the member, subject to exceptions. O. Reg. 367/11, s.34 (2), (a) and (b) Income includes, but is not limited to the following: (a) gross salaries, wages, overtime payments, commissions, bonuses, tips, gratuities; (b) self-employment income (c) the gross amount of unemployment insurance benefits; (d) the gross amount of workers compensation payments or other industrial accident insurance payments made because of illness or disability; (e) the gross amount of any old age security, federal guaranteed income supplement and spouse s allowance and financial assistance under the Ontario Guaranteed Annual Income Supplement (GAINS); (f) the gross amount of every kind of pension, allowance, benefit and annuity whether from a federal, provincial or municipal government of Canada or any level of government of any other country or state or from any other source; (g) the gross amount of alimony, separation, maintenance or support payments; (h) the gross amount of gains from investments including interest or dividends on stocks, shares or other securities, and where the actual income can not be determined, an imputed rate of return set by the Ministry of Municipal Affairs and Housing from time to time; (i) the gross interest income from savings or chequing accounts in a bank, trust company or a credit union; (j) the gross amount of interest earned or payable from bonds, debentures, term deposits or investments, certificates, mortgages or lump sum payments or other assets; (k) an imputed income equal to the total appraised value of all assets which do not produce interest income multiplied by a rate of return set by the Ministry of Municipal Affairs and Housing from time to time. Gross Household Income means the combined income of: 1. The applicant and every person residing in the leased premises; 2. Every applicant and co-applicant on the lease temporarily residing elsewhere. EXAMPLES OF POSSIBLE SOURCES OF INCOME (Domestic or Foreign) Pensions and Allowances Widow s Pension War Veterans Allowance (DVA) Old Age Security (OAS) Company Pension War Veterans Allowance (other countries) Guaranteed Income Supplement Private Pensions Military/Militia/Civil Defence Allowances Guaranteed Annual Income Public Service Pension Canada Pension (CPP) Supplement (GAINS) Civilian War Pension Training Allowances/Retraining Allowance Quebec Pension Plan Disability Pension Income Producing Assets Farm property which produces income Real estate (residential, commercial, farmland, cottage, mobile home) which produces rental income Savings accounts (bank, trust company, credit union), annuities, Guaranteed Investment Certificates, stocks or shares, bonds, debentures, mortgages, loans, notes, term deposits Licence which produces income (e.g. Taxi Licence) OTHER SOURCES OF INCOME Non-Income Producing Assets Life insurance (with cash surrender value) Real estate Collection of, or investments in, other valuable non-income producing assets (i.e. coins, stamps, antiques, art, etc) Business assets which do not produce income Non-interest bearing chequing accounts Business interest which produces income Employment (full-time, part-time, casual seasonal, odd jobs) Workplace Safety and Insurance Board (WCB) Insurance payments Provincial or municipal payments Employment Insurance Commission payments Payments under Compensation for Victims of Crime Act Payments from Official Guardian or Public Trustee Self-employment (child care, music teaching, business) Separation payments Alimony payments Support payments (for spouse or child) Support from relatives or other sources Mortgage income 9

Section 5 Income Statement of all MONTHLY income BEFORE deductions received by all persons/family residing in unit. Tenant Last Name Tenant First Name SOURCES OF INCOME Ontario Works Ont. Disability Support Program DVA Disability Pension Full Time Employment Part Time Employment Self Employment Employment Insurance Benefits (EI) W.S.I.B (Long Term/Short Term) Immigrant/Government Sponsorship C.P.P (Canada Pension Plan) Old Age Security (OAS) Gains Aged Company Pension U.S. Social Security Other Country Social Security Other Pensions War Veteran s Allowance Alimony/Support OSAP/Study Grants/Training Allowance Band Allowance Other Income Specify: TOTAL GROSS MONTHLY INCOME $ Members to live in the accommodations INCOME PRODUCING ASSETS Balance of Accounts/ Investments Savings Account Balance Chequing Account Balance Bonds/ GIC/ Term Deposits/ RRSPs/ RIFs Annuities/Shares/Stocks/Mutual Funds/Debentures Rent Revenue Life Insurance Policies(interest earned & value) Other -Specify: TOTAL INCOME PRODUCING ASSETS $ NON-INCOME PRODUCING ASSETS (Indicate appraised value. If appraised value is not known indicate tax assessment amount) Property Owned: House Cottage/Camp Vacant Property Outstanding Mortgage Business assets (Partnership, etc.) Paid -up Life Insurance Other-Specify: Property & Assets transferred within Past 3 Years Yes NO Item and value of item Transferred Transferred to and Date of transfer 10

Section 6 Housing Preferences Note: Select unit size based on your family size. These preferences will determine the properties that you are able to select on this application. Unit Size: Bachelor 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom Community Type: I/We want to live in a community for: Senior Non-Senior Project Type: I/We want to live in the following type of housing: Non-Profit Co-Op Rent Supplement Local Housing Corporation Wheelchair Accessible or Supportive Housing Needs Is a wheel chair site required? Is modified unit required? See Section 7 Is an elevator required? Single floor layout required? Do you need supports to live independently Please list any supports that you currently receive to enable you to live independently: Name of Agency Support Person Phone Number Documentation provided (optional) Other Details: Is an additional child expected (baby, adoption, etc.) If YES, Due Date (MM/DD/YYYY) Do all household members reside in present accommodation? If NO provide information in notes box: 11

Section 7 SPECIAL NEEDS/MODIFIED HOUSING Eligibility Requirements for Special Needs (modified) units: As per the Accessibility for Ontarians with Disabilities Act, 2005 (previously the Ontarians with Disabilities Act, 2001) and the Human Rights Code, R.S.O. 1990 disability means: (a) any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness and, without limiting the generality of the foregoing, includes diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or other animal or on a wheelchair or other remedial appliance or device, (b) a condition of mental impairment or a developmental disability, (c) a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, (d) mental disorder, or (e) an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997. Does your household require a special needs/modified unit as per the Accessibility for Ontarians with Disabilities Act, 2005 and the Human Rights code, R.S.O. 1990 definition? Yes No Number of members requiring a special needs unit in your household : An application by a household for special needs housing must include full particulars of the reasons for which one or more of the members of the household require special needs housing and must provide proper documentation to support his or her disability. This documentation must be obtained from a medical physician, a physiotherapist, a social worker, or the agency or organization specializing in the specific disability. [O. Reg. 367/11 s.69] Documentation attached supporting special needs housing For Office Use Only Date: Approved: The following housing providers provide special needs housing. Please check your preferences. Co-operative Housing Providers all units are townhouses La Chaumiere Co-operative Housing Inc. (East end) 2 & 3 bedroom units Orion Co-operative Housing Corporation (East end) 1, 2 & 3 bedroom units Vesta Co-operative Homes Inc. (West end) 2 & 3 bedroom units Haldimand Co-operative Housing Corporation (West end) 1, 2 & 3 bedroom units Pawating Co-operative Homes Inc. (Central) 1, 2 & 3 bedroom units Non-Profit Housing Providers multi-storey secured buildings with elevator Cara Community Corporation (CARA II) (Central) 2 bedroom units Sault Moose Lodge Housing Corporation (East end) 1, 2 & 3 bedroom units Croatian Housing Association of Sault Ste. Marie (Central) 1 & 2 bedroom units Cara Community Corporation (CARA III Highland Place)(Central) 1 & 2 bedroom units Seniors Non-Profit Housing Providers Must be 60 years of age or older to qualify Multi-storey secured building with elevator unless otherwise stated Lions Club of Sault Ste. Marie Housing Corporation (Downtown) 1 & 2 bedroom units St. Gregory's Senior Citizens Non-Profit Homes (West end, one-storey) 1 bedroom units Italian Housing Corporation (Downtown) 1 bedroom units RENT SUPPLEMENT multi-storey building with elevator Cara Community Corporation (CARA I ) (Central) 1 bedroom unit 12

STATUTORY DECLARATION I/We make the above, the following and all other, whether verbal or written representations, to the Sault Ste. Marie Social Housing Application Centre, (Application Centre) knowing that they will be relied upon by the Application Centre and its member social Housing providers, to assess my qualifications for rental accommodation and to establish rent: 1. I /We have read the definitions of Income and Gross Family Income set out on this form and I/we fully understand them. I/We understand the requirements for reporting all household income and assets and I/we agree to comply. I/We have reported all income received and all assets currently owned and any assets transferred within the last three years by every member of the household. 2. I/We have supplied the information in this application to the best of my/our knowledge and belief. All statements are true and no information, required to be given, has been withheld or omitted. 3. I/We understand that if rental accommodation is provided to me/us, that accommodation is to be occupied only by myself, the co-applicant(s) and those persons listed in Section 3 Other Members subject to approval. 4. I/We will notify the Application Centre within 30 days of any changes in my/our circumstances/application while I/we are on the waiting list. 5. I/We will notify the appropriate social housing provider within 30 days of any changes in my/our circumstances once I/we are placed in a housing unit. 6. I/We declare that I/we am/are in Canada legally. 7. I/We understand that it is an offence, under the Housing Services Act, 2011, for an applicant or any individual to knowingly obtain or assist a household member to obtain rent geared to income assistance for which they are not entitled. Such an offence carries up to a $5,000 fine and/or up to 6 months imprisonment as well as a prohibition from re-applying for assistance for a period of two years. If something on this application is missing, incorrect or false, the Application Centre, or the housing providers I/we have applied to may request additional information or may cancel my/our application. CONSENT TO DISCLOSE AND VERIFY INFORMATION 1. The disclosure of information contained in this application and associated documents and verification is done for the purpose of processing the application including, but not limited to: determining the eligibility of the household for subsidized housing, determining the size and type of unit in respect of which the household is eligible to receive subsidized housing, determining the placement of the household on waiting lists and determining the amount of gearedto-income rent/housing charge payable by the household. Any information contained on this form, or in attachments, is collected by the Application Centre and associated housing providers, pursuant to the Housing Services Act, 2011). Inquires relating to this collection should be directed to the Application Centre, 180 Brock St., Sault Ste. Marie, ON P6A 3B7 (705) 759-7748. This information will be used to determine the eligibility of housing applied for, the continuation of eligibility for geared-to-income housing, and may be used to determine the appropriate geared-toincome rent/housing charge and other purposes allowed by law. 2. I/We agree to provide any supporting material required for my/our application. 3. I/We further consent to the Application Centre or to its member social housing providers, disclosing to any party personal information about any member of the household, for the purpose of determining or verifying my/our initial or continued rent-geared-to-income assistance or administering my/our rent-geared-to-income assistance. 4. I/We consent to the release of any information to the Application Centre about any bank account, safety deposit box, assets of any nature or kind held by me/us, or on my/our behalf, or by or on behalf of any of my/our dependants or children temporarily in my/our care, alone or jointly with any other person in any financial institution. 5. I/We further consent to the exchange of information with any social housing provider associated with the Application Centre, an Ontario Works delivery agent, a credit bureau, the Government of Canada, the government of any other province or territory, the Government of Ontario, or any agency, Ministry or department of any of the foregoing, or any party in order to verify information for the purposes of determining or verifying initial or continued eligibility for and administration of my/our rent-geared-to-income-assistance. Any arrears information will be shared with Access Centres across the province once the lease or occupancy agreement is terminated. 6. I/We understand that this consent will apply to inquiries made relating to my/our initial eligibility for, as well as my/our past and present receipt of rent-geared-to-income assistance. I/we further understand that the inquiries may take the form of electronic data exchanges. 13

STATUTORY DECLARATION cont d 7. I/We, undersigned, understand that any member of the household may make a request for an internal review of certain decisions made, with which I/we do not agree, regarding this Application for housing and, if housed, regarding the subsidized tenancy. 8. I/We hereby release the Application Centre, all associated housing providers, any employee, officer, agent or contractor from any liability or claim arising from the collection, storage, use or dissemination of any information received or collected pursuant to this Declaration, Release and Consent to Information. In the event that I/we am/are provided with rental accommodation as a result of my/our application, I/we acknowledge that my/our eligibility shall be reviewed at least every twelve (12) months and that I/we have the same obligation to provide information required by the review. In the event that I/we am/are provided with rental accommodation, this Declaration, Release and Consent to Information shall remain in force and be enforceable against me/us by the Application Centre and my/our housing provider, in addition to any other obligations with respect to the Declaration, Release and Consent to Information which may be imposed upon or agreed to by me/us. 9. I/We understand that any information on this form and any attachment given by the Application Centre to a body listed above is confidential and will only be given in accordance with the Housing Services Act, 2011. Signature of Applicant Date Signature of Co-Applicant Date Signature of Co-Applicant Date Witness Date Notice with Respect to the Collection of Personal Information (Personal Information Protection and Electronic Documents Act) (Freedom of Information and Protection of Privacy Act) (Municipal Freedom of Information and Protection of Privacy Act) This information is collected under the legal authority of the Housing Services Act, S.0. 2011, c. 6, Sched. 1, s.169 (1). The information will be used to determine suitability and eligibility for housing applied for, continuation of housing and the appropriate rent scale and rent-geared-to-income charge. Personal information may be disclosed to non-profit housing corporations, the Ministry of Municipal Affairs and Housing and other municipal/provincial and federal departments and agencies who assist in the provision of affordable housing; Province-wide Arrears data base and to social and government agencies providing social assistance to the applicant in accordance with the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F. 31, as amended, and the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.-56, as amended. Housing Services Act, S.0. 2011, c. 6, Sched. 1, s.169 (1). 14

Section 8 - -UNIT SELECTION - Please indicate your selection by checking the box to the left of the location DOWNTOWN - ADULT AND FAMILY UNITS LEGEND: SSMHC Sault Ste Marie Housing Corporation R/S Rent Supplement Unit BOLD indicates NON-SMOKING UNITS & PROPERTIES 1 BEDROOM UNITS Select All LOCATION PROVIDER FEATURES 588 Albert St. W SSMHC Multi storey with elevator 100 James St. R/S - 100 Rentals Inc Multi storey with elevator 615 Albert St. W R/S - The Periza Group Ltd. Multi storey with elevator 555 Albert St. W R/S - Silver Shade Prop. Inc. Multi storey with elevator 49 St Mary s River Dr. R/S - Algoma Central Prop. Inc. Multi storey with elevator 700 Bay St. R/S - 700 Bay St. Corp. Multi storey with elevator 70 East St. R/S - Old Hall Complex. Ltd Multi storey with elevator 30 Albert St. E R/S 2 storey walk up 250 Albert St. E R/S - InterRent SSMarie No. 2 Multi storey with elevator 441 Queen St. W R/S 3 storey walk up 275 Albert St. E. R/S - Campbell Place Inc. Multi storey with elevator 445 Wellington St. E. R/S Duplex 160 Bruce Street R/S Duplex 175 Queen St. E. R/S Apt first floor 182 Wellington St. East R/S Duplex - walk up 132 Spring Street R/S Apt. 903 Queen Street R/S 2 storey walk up 2 BEDROOM UNITS Select All 100 James St. R/S - 100 Rentals Inc Multi storey with elevator 555 Albert St. W R/S - SilverShade Prop. Inc. Multi storey with elevator 250 Albert St. E R/S - InterRent SSMarie No. 2 Multi storey with elevator 615 Albert St. W. R/S - The Periza Group Ltd. Multi storey with elevator 3 BEDROOM UNITS Select All 100 James St. R/S - 100 Rentals Inc Multi storey with elevator 615 Albert St. W. R/S - The Periza Group Ltd. Multi storey with elevator 15

CENTRAL - ADULT AND FAMILY UNITS LEGEND: SSMHC Sault Ste Marie Housing Corporation R/S Rent Supplement Unit BOLD indicates NON-SMOKING UNITS & PROPERTIES 1 BEDROOM AND BACHELOR UNITS Select All LOCATION PROVIDER FEATURES Brien /Poplar/ McNabb SSMHC Apt. complex with bachelor units Brien /Poplar/ McNabb SSMHC Apt. complex with 1 bedroom units 731 Pine Street R/S - Pine/Hill Apts. Apt. - walk up 101 Chapple St. SSMHC Apt. - 2 storey walk up 345 St. George s Avenue SSMHC Apt. - 2 storey walk up 53 Chapple Street SSMHC Apt. - 2 storey walk up 602/614 MacDonald Avenue R/S Elstrong Management 3 storey walk up 76 Allard Street R/S - Pine Hill Apts. Apt. - walk up 751/769 Pine & 94/108 Allard R/S - Pine Allard Properties Multi storey with elevator 17 Boston Avenue R/S Apt. - 2 storey walk up 621/627/631 MacDonald Ave R/S - Heritage Place Multi storey with elevator 80 Sackville Road Croatian Housing Assoc. Multi storey with elevator 77 Allard St. ( Highland Place) Cara III Community Corp. Multi storey with elevator 58 Pawating Place Pawating Co-Operative Townhouse 21 Ferguson Avenue R/S Apt.-walk up 328 McNabb Street R/S Apt-walk up 59 Old Garden River Road Cara II Community Corp. Multi Storey with elevator 31 Old Garden River Road R/S - Cara I Community Corp. Multi Storey with elevator 2 BEDROOM UNITS Select All Brien/ Smale/Cunningham SSMHC Single detached 1 storey bungalow Chapple Street SSMHC Townhouse 2 storey 652 Mac Donald Avenue R/S - Frank Hilb Real-estate Multi Storey with elevator 621/627/631 MacDonald R/S Heritage Place Multi storey with elevator 17 Boston Avenue R/S - 746487 Ont. Ltd. Apt. 2 storey walk up Brien/Poplar/McNabb SSMHC Apt. complex walk ups 171 Willow Avenue R/S - Pine Allard Properties 2 storey walk up Apt. 751/769 Pine & 94/108 Allard R/S - Pine Allard Properties Multi storey with elevator 58 Pawating Place Pawating Co-Operative Townhouse 80 Sackville Road Croatian Housing Assoc. Multi storey with elevator 77 Allard St. ( Highland Place) Cara III Community Corp. Multi storey with elevator 59 Old Garden River Road Cara II Community Corp. Multi storey with elevator 277 Northern Avenue East Columbus Club Housing Co. Multi storey /elevator 235 Upton Road R/S Arcon Investment Apt. 2 storey walk up 101 Chapple SSMHC 2 storey walk up Apt. 31 Old Garden River Road R/S Cara 1 Community Corp. Multi storey with elevator 3 BEDROOM UNITS Select All Boston Ave. SSMHC Townhouse 2 storey Chapple & Albion Street SSMHC Townhouse 2 storey Brien, Campbell, Crawford, SSMHC Single detached 2 storey bungalow Weldon, Cunningham, Smale 123 & 131 Willoughby Avenue SSMHC 4 plex 751 Pine R/S - Pine Allard Properties Multi storey with elevator 59 Old Garden River Road Cara II Community Corp. Multi storey with elevator 277 Northern Avenue East Columbus Club Housing Co. Multi storey /elevator 58 Pawating Place Pawating Co-Operative Townhouse 4 BEDROOM UNITS Select All Boston Avenue SSMHC Townhouse 2 storey Chapple & Albion Streets SSMHC Townhouse 2 storey 16

EAST - ADULT AND FAMILY UNITS LEGEND: SSMHC Sault Ste Marie Housing Corporation R/S Rent Supplement Unit BOLD indicates NON-SMOKING UNITS & PROPERTIES 1 BEDROOM AND BACHELOR UNITS Select All LOCATION PROVIDER FEATURES 819 Trunk Rd. R/S - 2178454 Ontario Ltd. 3 storey walk up- bachelor units 819 Trunk Rd. R/S - 2178454 Ontario Ltd. 3 storey walk up- one bedrm units 115/125/135 Cambridge Pl R/S - Silver Mgmt Group 2 storey walk up Apt. 191 South Market R/S - Elstrong Management 2 storey walk up Apt. 23/26/27 Terry Fox Place R/S - Fleming & Smith Ltd. 3 storey walk up 17 Terry Fox Place R/S - Elstrong Management 3 storey walk up 99 Cambridge Place R/S - Elstrong Management 2 storey walk up 539 Trunk Rd. Sault Moose Lodge Housing Multi storey with elevator 95 Constellation Place Orion Co-Operative Homes Townhouses 352A & 352B Dacey Road R/S - Skyline 3 storey walk up 118 Breton Road R/S - Greg Apts. Ltd. Apartment Bldg 2 BEDROOM UNITS Select All 115/125/135 Cambridge Pl R/S - Cheval Developments 2 storey walk up Apt. 99 Cambridge Place R/S - Elstrong Management 2 storey walk up 23/26/27 Terry Fox Place R/S - Skyline. 3 storey walk up 95 Constellation Place Orion Co-Operative Homes Townhouses 539 Trunk Rd. Sault Moose Lodge Housing Multi storey with elevator 101 La Chaumiere Place La Chaumiere Co-Operative Townhouses 819 Trunk Road R/S - 2178454 Ontario Ltd. 3 storey walk up 78 Breton Road R/S Apartment Bldg. 3 BEDROOM UNITS Select All 66-92 Adrian Dr. SSMHC Semi detached Shannon Rd. & Capp Ave. SSMHC Duplex 22, 68, 84, 133 Murphy St. SSMHC 1 & 2 storey detached homes 52, 89, 104 Willowdale Ave. SSMHC 1 & 2 storey detached homes 95 Constellation Place Orion Co-Operative Homes Townhouses 539 Trunk Rd. Sault Moose Lodge Housing Multi storey with elevator 101 La Chaumiere Place La Chaumiere Co-Operative Townhouses 4 BEDROOM UNITS Select All Shannon Rd. & Capp Ave. SSMHC Semi detached 15, 77 Murphy St. SSMHC 1 & 2 storey detached homes 112 River Rd SSMHC 1 & 2 storey detached homes 5 BEDROOM UNITS Select All 69 87 Adrian Dr. SSMHC Semi detached 17

WEST - ADULT AND FAMILY UNITS LEGEND: SSMHC Sault Ste Marie Housing Corporation R/S Rent Supplement Unit BOLD indicates NON-SMOKING UNITS & PROPERTIES 1 BEDROOM UNITS Select All LOCATION PROVIDER FEATURES 525 Cooper St. R/S 3 storey walk up 537 Cooper St R/S Multi storey elevator 551 Cooper St R/S Multi storey elevator 707A Second Line West R/S - SarGin Developments 2 storey walk up 1001 Second Line West Haldimand Co-Operative Townhouses 504 Third Avenue R/S 2 storey - walk up 634 Connaught Ave. R/S Apt. - walk up 490 Wallace Terrace R/S Duplex - walk up 670 Korah Road R/S Four Plex walk up 321 Wellington Street West R/S Apt.-walk up 352 Wellington Street West R/S Four Plex- walk up 2 BEDROOM UNITS Select All 676-714 Second Line West SSMHC Townhouses 1001 Second Line West Haldimand Co-Operative Townhouses 50 Creekside Lane Vesta Co-Operative Homes Townhouses 335 Wellington St. W. R/S 2 storey- duplex walk up 504 Third Avenue R/S 2 storey walk up 3 BEDROOM UNITS Select All 676-714 Second Line West SSMHC Townhouses 11, 13, 15 Durban Road SSMHC 1 storey detached homes 29-41 St Basil s Road SSMHC 1 storey detached homes 1001 Second Line West Haldimand Co-Operative Townhouses 50 Creekside Lane Vesta Co-Operative Homes Townhouses 4 BEDROOM UNITS 676-714 Second Line West SSMHC Townhouses 5 BEDROOM UNITS Select All 415 435 Sydenham Road SSMHC 2 storey detached homes The following Federal Housing Providers have their own Application. You must apply at each individual Provider if interested. Neech-Ke-Wehn Homes Inc. William McMurray Corporation The Ontario Finnish Resthome Association (Kotitalo) Cara Community Corporation (Cara I) 18

SENIOR UNITS CENTRAL BOLD indicates NON-SMOKING UNITS & PROPERTIES 1 BEDROOM UNITS Select All LOCATION PROVIDER FEATURES 55 Chapple St. Sault Ste Marie Housing Corp 3 storey with elevator 277A Northern Ave East Columbus Club Housing Co. Multi storey with elevator 725 North Street Ontario Finnish Rest Home Multi storey with elevator 2 BEDROOM UNITS 277A Northern Ave East Columbus Club Housing Co. Multi storey with elevator DOWNTOWN 1 BEDROOM UNITS Select All LOCATION PROVIDER FEATURES 615 Bay Street Sault Ste Marie Housing Corp Multi storey with elevator 4 East Street Italian Housing Corporation Multi storey with elevator 623 Bay Street Lions Club of SSM Multi storey with elevator 2 BEDROOM UNITS Select All 4 East Street Italian Housing Corporation Multi storey with elevator 623 Bay Street Lions Club of SSM Multi storey with elevator WEST 1 BEDROOM UNITS Select All LOCATION PROVIDER FEATURES 393 Dovercourt Road St Gregory s Non Profit One storey apartment building The following Federal Housing Providers have their own Application. You must apply at each individual Provider if interested. Neech-Ke-Wehn Homes Inc. William McMurray Corporation The Ontario Finnish Resthome Association (Kotitalo) Cara Community Corporation (Cara I) 19