Application for Rent-Geared-to-Income Housing Prince Edward - Lennox & Addington Social Services Instructions for Completing the Application for Rent-Geared-to-Income Housing 1. Please fill out all sections of the Application form. 2. Please have all household members that are 16 years of age and over:  read and sign the Consent and Release form (page 6)  read and sign the Declaration (page 7) 3. You may be asked for proof of any information you give in your Application. 4. If you need any assistance or have any questions about completing the Application, please contact Prince Edward - Lennox & Addington Social Services. Phone: (613) 354-0957 Toll Free: (866) 354-0957 After you have completed the Application form, please return it: By Mail: Prince Edward - Lennox & Addington Social Services 95 Advance Avenue Napanee, Ontario, K7R 3Y5 By Email: [email protected] By Fax: (613) 354-4099 By Drop Off: Prince Edward - Lennox & Addington Social Services 95 Advance Avenue Napanee, Ontario, K7R 3Y5 Prince Edward - Lennox & Addington Social Services 229 Main Street Picton, Ontario, K0K 2T0 Prince Edward - Lennox & Addington Social Services 20 Manitou Crescent West Amherstview, Ontario, K7N 1B4 Prince Edward - Lennox & Addington Social Services 12497A Hwy 41 Northbrook, Ontario, K0H 2G0 Please ensure your Application is completed in full as incomplete Applications will not be processed. Please keep this page for your records. It is your responsibility to notify us immediately if you move or your phone number changes. Blank Page Do Not Remove Applicant Information Name Date of Birth (DD/MM/YYYY) Social Insurance Number Marital Status Please provide an address and phone number(s) where we can safely contact you. Unit Number Street Number Street Name Town/City Province PO Box Postal Code Preferred Communication  Phone  Text  Email  Letter  Other, provide details Preferred Number/Address for Communication: Please tell us immediately if you move or if your telephone number changes. If we cannot contact you, your name may be removed from the Rent-Geared-to-Income Housing wait list. Alternate Contact Information / Alternate Contacts Request for Special Priority An applicant whose personal safety or that of their family is at risk because of abuse by a person they live with (or have recently lived with) will be given consideration for the status of Special Priority Rent-Gearedto-Income Housing wait list. To apply for Special Priority Status (SPP) you must submit a Special Priority Application Package which can be obtained from Prince Edward - Lennox & Addington Social Services. Are you, or any member of your household, requesting to move from an abusive relationship and therefore, are requesting Special Priority?  No, I am not requesting Special Priority  Yes, I am requesting Special Priority and the Request for Special Priority Application is attached  Yes, I intend to submit the Request for Special Priority Application Package at a later date Office Use Only Application for Rent-Geared-to-Income Housing 04.2021 Page 1 Household Information Please provide all information about all adults and children who will be living with you. First Name Last Name Relationship to applicant (ie. spouse, child) Date of Birth (DD/MM/YYYY) Social Insurance Number Parental Declaration - Please skip if you have not listed any dependents on Page 1 I state that the current custody/visitation arrangements of my noted child(ren) on Page 1 are:  My child(ren) has/have lived with me and has/have been in my care and custody since birth. There are currently no court orders or documents dealing with the custody of my child(ren) listed.  I have shared custody arrangements and have regular overnight visitation with my child(ren)  There is a plan of care to have overnight visitation with my child(ren) and I have attached written verification from The Children’s Aid Society (CAS) to this Application. Additional Comments: _________________________________________________________________ ___________________________________________________________________________________ Additional Information Are you, and all the people in the household, Canadian Citizens?  Yes  No If no, please provide details: ____________________________________________________________ (ie. Permanent Resident, Sponsored Immigrant, etc.) Is an additional child expected to join your household (baby, adoption etc

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