Housing Application

Who should use this form?

You may be eligible for Supportive Housing if you:

are low-income;
are homeless or at-risk of homelessness;
may have mental health and/or mental and physical health needs;
require support services to help maintain a successful tenancy.

Note: If you are living in supportive housing and want to move, speak to your housing provider or contact the Supportive Housing Registry and ask for a Transfer Form.

Additional Information

Most supportive housing units are studios suitable for a single individual. Very few buildings have units with one or more bedrooms.

If you wish to live with or near another individual, you both must:

complete a Supportive Housing Registry Application Form; and
sign a SHR Request to Link form.

The SHR Request to Link form can be obtained by contacting our office or downloaded from our website at www.bchousing.org/SH.

Application Form

Step 1 of 6

What is Supportive Housing and the Supportive Housing Registry (SHR)?

Supportive housing provides a private room or apartment in a building with support services. Buildings and units vary in style, size and supports provided.

The Supportive Housing Registry provides a single point of access for supportive housing. Applicants apply only once instead of separate applications with multiple housing providers.

BC Housing works with supportive housing providers, health authorities and other community partners to access the accommodation that best meets your needs.

More information on supportive housing is available online at www.bchousing.org/SH.

How to Apply:

Step #1: Complete the Application Form in full.
Step #2: Sign and date the Declaration and Consent at the end of the form.
Step #3: Submit the application

1. Applicant: Please tell us about yourself

Last Name:(Required)

First Name(s)(Required)

Alias or Nickname (optional)

Birthdate(Required)

Gender(Required)

2. What city/town do you currently stay in?

City/Town(Required)

City

How long have you been here?(Required)

Is there a specific neighbourhood you stay in? (optional)

3. How can we reach you?

Your Phone number(Required)

Your Email address(Required)

Your Address or an address you can recieve mail (if applicable).

Street Address Address Line 2 City Province Postal Code

3a. Is there anyone we can leave a message with in order to contact you? (provide as many options as possible)

Contact Information

Contact or Organization Name

Phone Number

Contact's relationship to you

*Authorized Contact (Yes/No)

*By saying Yes under Authorized Contact, you are confirming that you have the contact’s permission to provide their information and you are giving permission for the Supportive Housing Registry and any supportive housing provider to exchange information with that contact in order to maintain and update your application. Authorized Contacts can be added or removed by contacting the Supportive Housing Registry.

Important: If we are unable to contact you, we will move to the next applicant.

4. Financial Sources

What are your sources of income?(Required)

On income assitance

Other income

No income

Income Sources

List all sources and amounts. (if on income assitance, specify if employable, PWD or PPMB)

Name

Amount ($ Monthly)

Indigenous Status

Do you identify as being an Indigenous person in Canada?(Required)

Yes

Prefer not to answer

Note: Some housing providers manage supportive housing that gives priority to Indigenous persons. This answer will assist them with identifying Indigenous applicants. This information is also used for planning and reporting purposes.

6. Housing Needs and Preferences

The following questions will assist with assessing your eligibility for supportive housing and matching you to housing that best meets your needs.

Current Living Situation(Required)

Please select the one option that best describes your current living situation:

Staying with friends/relatives

Sleeping outside

At an Emergency Shelter

Correctional Facility

Treatment facility/detox

Hospital

Private Market – Single Room Occupancy Hotel

Private Market – own unit/suite

Other (Specify):

You indicated "other", please specify.(Required)

Is there a deadline to leave your current living situation?(Required)

Yes

If yes, what is the date?(Required)

Why do you need or want to move?(Required)

7. Health and Mobility

Describe health conditions or disabilities that impact your ability to obtain or maintain housing.(Required)

Mental Health

Physical Health

Substance Use

No Health Conditions

Mental Health Description/Impact(Required)

Physical Health Description/Impact(Required)

Substance Use Description/Impact(Required)

7a. Stairs and Wheelchair Access

Let us know if you have any difficulty with stairs or use a wheelchair.(Required)

Stairs are OK

No Stairs

Limited number of stairs

How many?(Required)

Do you require wheelchair accessible housing?(Required)

Yes

Pets/Animals

Please tell us about any pets you have.

Do you have any pets?(Required)

Yes

If yes, how many?(Required)

What kind?(Required)

Do you have a registered therapy or service animal?(Required)

Yes

If yes, please describe.(Required)

9. Where would you prefer to live?

Important: Eligible applicants are considered for supportive housing units located in or near the city or town where they currently stay. If you wish to be considered for other areas, please list below.

In addition to buildings in or near where I currently stay, please consider me for:

Cities or Towns

Neighbourhoods

Buildings

Important: If we don’t hear from you at least every 6 months your file goes on hold and an offer of housing cannot be made. You can contact the Supportive Housing Registry to update your preferences at any time.

Declaration and Consent

Please read and sign.

I declare:

This is my application to be considered for supportive housing and all the information in it is true, correct and complete.

I consent:

To BC Housing sharing my information with supportive housing providers, health authorities, shelter providers, outreach providers, and/or other organizations partnering with BC Housing to coordinate access to suitable housing for me.
To supportive housing providers, health authorities, shelter providers, and/or outreach providers who are directly involved in finding suitable housing for me to make any necessary inquiries to verify the information given in this application; and, for any person, corporation or social agency to release any necessary information to the assessment of my eligibility for supportive housing.
To members of the Supportive Housing Registry to exchange information with my Authorized Contact(s) in order to maintain and update my application.

I understand:

This application is not an agreement on the part of the Supportive Housing Registry or supportive housing providers to provide me with housing.
It is my responsibility to contact the Supportive Housing Registry at least once every six (6) months for my file to remain active.
If there is a unit available and I cannot be contacted, the Supportive Housing Registry will offer the unit to another applicant.
If I am being considered for an available unit, I may be asked to provide additional information to assess if the supports provided in that building will meet my needs and it is my responsibility to provide or cause to be provided information requested to assist with this assessment.
If I wish to withdraw this Declaration and Consent, I may do so at any time by contacting the Supportive Housing Registry; however, withdrawal will result in my no longer being considered for supportive housing.

Applicant name(Required)

Signed on(Required)

Purpose of this form: Personal information is collected on this form to identify and contact you, to assess your eligibility for supportive housing and to determine the housing that meets your needs. The information is collected in accordance with section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about your personal information, please call or write the Privacy Officer at BC Housing,

1701 - 4555 Kingsway, Burnaby, BC, V5H 4V8

, 604-433-1711.