Housing Application

Date of Application

Name of Applicant

Treaty Number

Name of Spouse (if applicable)

Mailing Address

Phone

Marital Status

List your immediate family members/relatives who will be living with you. Please include name, age, relationship and treaty number for each person.

How long have you been a resident on the reserve?

What kind of house are you apply for?

Any Vacant Unit

New CMHC Unit

Addition or Renovation

Under the Housing Policy it states that you must pay rent if you are working, on OAS, Employment Insurance and any other Federally Funded Program. Are you willing to pay rent?

Yes

No

Not Applicable

Do you presently reside in a unit on IR100 or IR100A?

Yes

No

If so, what is the address and year it was built?

Have you ever received a new house?

Yes

No

Additional Comments

I agree that if awarded anew unit I will abide by the Band's Housing and Rental Policies.

Signature