THE GOOD SAMARITAN PLACE 8425-83 Street Edmonton, AB T6C 2Z2 (780) 989-3282 The Good Samaritan Place is owned and managed by the Good Samaritan Society (A Lutheran Social Services Organization). All applicants for tenancy must be 60 years or older and the site is designed for independent living. A shopping mall, library, medical centre, swimming pool, public transportation, churches of many faiths and a Senior Citizen s Centre are all located in the immediate area. BUILDING FEATURES SUITE FEATURES Seven storey senior citizens residence designed for independent living. It contains 2 elevators and 40 - one bedroom suites. The CHOICE Program occupies the first and second floor. The main floor contains a dining room and recreation room for tenants to enjoy evenings and weekends. Complimentary Laundry facilities are located on each floor. There are two suite designs: open or closed style. Each suite has a large bay window that opens, an electric stove, refrigerator, thermostat temperature control, smoke/heat detector, a heat lamp and grab bars in the bathroom for the convenience of our tenants. Cable TV is included in the rent. PARKING Limited outdoor parking is available with plug-ins at a cost of $ /month. PETS No Pets Allowed. RENT Rent is $ /month. Rent will be withdrawn through pre-approved payment once per month. DAMAGE DEPOSIT Damage deposit is equivalent to the first month s rent. The deposit will be refunded (less the cost of repairs/cleaning) when suite is vacated. Form 6083 CHOICE GSP Apartments 17Jul 2015 Page 1 of 7
ON-SITE SERVICES Hot Lunches - Hot lunch is offered at a cost Monday to Friday in the main floor dining room; closed Statuatory Holidays and weekends. Hair Salon - Open at 10 a.m. appointments offered Wednesday, Thursday & Friday. Library Books - available for borrowing every second Saturday. Delivered by the book-mobile from the Edmonton Public Library; kept on-site and changed every 3 months. Bi-Monthly Newsletter - is produced and distributed to tenants. A copy is also placed on the Tenant bulletin board. This newsletter includes building information and upcoming social events/activities coordinated by the Tenant Seniors Club. Some of the coordinated activities include: - Bagged Lunch - Saturdays at noon bring your lunch and visit with fellow tenants. $0.25 cost for Coffee or Tea; held in the dining room. - Seniors Club Meeting - Held on the first Saturday of each month, for more information see the Tenant Bulletin Board. - Birthday Parties - $2.00 is charged for entertainment. Coffee and cake free. Held in the dining room at 6:30 p.m. the second Friday of each month. - Door Sign Checks - Volunteers on each floor check door signs each morning. Form 6083 CHOICE GSP Apartments 17Jul 2015 Page 2 of 7
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GOOD SAMARITAN PLACE APARTMENTS APPLICATION FOR ACCOMMODATION Please complete fully, as the information will be used to prioritize placements on the waiting list. Office Use Only Date Received: Return to: Attention: Site Coordinator The Good Samaritan Place 8425 83 Street Edmonton, Alberta T6C 2Z2 Applicant 1 1. Last Name: First Name: Present Address: Postal Code: Telephone: Birthdate: Applicant 2 2. Last Name: First Name: Present Address: Postal Code: Telephone: Birthdate: Form 6083 CHOICE GSP Apartments 17Jul 2015 Page 5 of 7
3. PLEASE CHECK YOUR REASON(S) FOR CONSIDERING A MOVE TO THE GOOD SAMARITAN PLACE: Present accommodation is too expensive Desire for companionship Unable to physically maintain your own home To be closer to family / friend support Shared accommodation (shared home) Housing detrimental to health Eviction Special Circumstances (please specify) Is there any other special urgency or need for leaving your present accommodations? Please comment: 4. CONTACT PERSON(s) (In case of emergency) (1) Name: Relationship: Telephone (HM) (WK) (Cell) (2) Name: Relationship: Telephone (HM) (WK) (Cell) Form 6083 CHOICE GSP Apartments 17Jul 2015 Page 6 of 7
5. INCOME Please tell us the approximate amount and source of your gross household income. (This information will be kept strictly confidential) Source of Income: Monthly Old Age Security Guaranteed Income Supplement Assured Income for the Severely Handicapped (AISH) Alberta Assured Income Supplement Widowed Pension Canada Pension Plan Company Pension War Veterans Allowance Employment Income Social Assistance Other Income: (Specify) $ $ $ TOTAL INCOME: 6. Reference: Please give the name of a person, other than a relative or your Doctor, whom we may contact. Name: Relationship: Telephone (HM) (WK) (Cell) 7. Parking Stall Required: YES NO I hereby certify that the information I have provided is true, correct and complete, to the best of my knowledge. Signature of Applicant 1 Date: Signature of Applicant 2 Date: Form 6083 CHOICE GSP Apartments 17Jul 2015 Page 7 of 7