Affordable Rental Housing Application Form

"*" indicates required fields

1. Applicant Information

List yourself and all potential household members for subsidized housing. If required, attach a separate sheet for more names.

Last Name	First name(s)	Relationship to Applicant	Date of Birth (dd/mm/yyyy)	Gender Identity	Status in Nunatsiavut*	Actions

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2. Residential Address

Those who currently reside in Nunatsiavut will be prioritized for the Affordable Rental Program.

Street Address Address Line 2 City ZIP / Postal Code

Mailing Address

If different from home address

Street Address Address Line 2 City ZIP / Postal Code

3. Contact Information

Cell phone*

Other phone

Email*

Name of person we can leave messages with

Message person phone number*

Authorized contact Name

Authorized contact* name and relationship to you

Authorized contact phone number

Note: By providing an authorized contact, you are giving permission for NHC to exchange information with that authorized cont act in order to maintain and update your applicant file. To remove an authorized contact, please contact the NHC.

4. Residence History

4a. Please provide information on where you have lived for the last five years.

Address	From	To	Landlord Name	Landlord Phone Number	Reason for Leaving	Actions

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4b. Have you or any members of your household ever lived in subsidized housing?

Yes

If so, list the name(s) on the tenancy

Building name and/or address

Street Address Address Line 2 City ZIP / Postal Code

Note: Failure to declare any previous subsidized tenancies may result in cancellation of your application. Past tenants with debt may be required to either repay the debt or enter into a repayment agreement.

5. References (Optional)

If you did not list a current or previous landlord in Question 5, please include a reference that has observed your character over a reasonable amount of time. Examples: employer, past employer, pastor, outreach worker or health worker.

Name	Relationship	Phone Number	Actions

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6. Income Information

6a. List all gross (before deductions) monthly income for household members aged 19 and older.

Name	Income Source (Income Assistance, employment, EI, pension, etc.)	Gross Monthly Income ($)	Disability Income?	Actions

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6b. Is any adult child (ages 19 – 24) a full-time student in the household?

*Please provide required proof of full-time student status and suggested proof of income documents as stated in the checklist.*

Yes

7. Current Accommodation

7a. Are you currently renting?

Yes

If you are renting, how much is your monthly rent payment? $

7b. Please describe your current living arrangements.

House/Townhouse

Apartment/Basement

Manufactured Home/Trailer

Sleeping Outside

Staying with Family

Staying with Friends

Motel/Hotel

Transition Home

Second Stage Housing

Care Facility or Treatment Centre

Emergency Shelter

Other

Other living arrangements

7c. How long have you been in your current living arrangement?

7d. Have you received a legal Notice to End Tenancy?

Yes

If yes, when do you have to move by?

*Please provide a copy of the Notice to End Tenancy form (if applicable) as stated in the checklist.*

7e. Is there anything else that you want to share with a potential landlord about your current living situation?

8. Health and Mobility Information

8a. Do you, or any members of your household, have challenges with stairs?

I/We can do stairs

I/We cannot do stairs

I/We can only do a few stairs

How many steps?

8b. Do you, or any member of your household use a:

Wheelchair?

Yes

Scooter?

Yes

If yes, who?

Used inside the home?

Yes

8c. Please only list health conditions or disabilities that would affect your housing needs.

Name of Household Member	Health Condition or Disability	Actions

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8d. Please describe any health concerns that are affected by your current housing.

8e. Please describe any special requirements or features that you may need in your housing (e.g., grab bars, a ramp). Please note that special requirements or features may limit the number of unitsthat you are eligible for.

9. Housing Options

9a. Are you willing to live in a non-smoking/vaping free building and sign a non-smoking agreement?

Yes

9b. Provide the following information for all household pets

Dog

Yes

How Many Dog?

Accredited dog under the “Guide Dog and Service Dog Act:”

Yes

Cat

Yes

How Many Cat?

Describe About Cat

Other Animal

Yes

How Many Animal?

Describe About Other Animal

10. Where do you want to live?

Please use the Housing Listings in the most recent public announcements on unit availability to tell us where you would like to apply, if relevant. You can request a physical copy of the Housing Listings by phone at 709-896-4081. Please be careful when selecting buildings and be sure you are prepared to live in any of the buildings or areas that you list.

Note that you may apply at any time and indicate a general preference for a community only, if no unit vacancies are currently advertised. You will be added to the waitlist until a unit in your preferred community becomes available for consideration.

Option #1: Buildings

From the Housing Listings, please record the Code for each of the buildings you are interested in (e.g., HOP-100). There is no limit on the number of buildings that can be selected for your application. If the building does not have a Code, contact the NHC directly.

Option #2: Communities

Please record the Inuit Communities you are willing to live in (Nain, Hopedale, Postville, Makkovik, and Rigolet).

11. Optional Supplemental Application (If Applicable)

The NHC may give additional consideration to applicants who:

are homeless or at risk of homelessness;
are at risk of being separated from your children due to an inadequate housing assessment;
are fleeing domestic violence or abuse; or
have a serious health condition, including addictions, that is affected by current housing.

Applicants who meet these criteria can provide details below, or in an attached letter:

Proof of status in Nunatsiavut for all household members

Copy of Status as a Nunatsiavut Beneficiary

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Max. file size: 100 MB.

Copy of Canadian birth certificate(s) or Canadian passport(s) if born in Canada and a non-Beneficiary

If not born in Canada, please provide one of the following:

Record of Landing (IMM1000) or Confirmation of Permanent Residence (IMM5292/IMM5688); or
Permanent Resident Card (front/back); or
Any immigration document showing the date landed and the immigration code; or
Canadian Citizenship Card, Canadian Citizenship Certificate, or Canadian Passport; or
Refugee Protection Claimant Document (RPCD) or Notice of Decision.

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Max. file size: 100 MB.

Proof of student status for all adult children aged 19 – 30 who are full-time students.

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Max. file size: 100 MB.

Proof of address and rent

Copy of current rent receipt or recent rent increase notice; or
Copy of lease or tenancy agreement showing current rent amount; or
If you own your home, or stay with family in a privately-owned home, provide proof of address with a utility bill, or letter from homeowner stating you reside at the address and that they are the homeowner—further explanation as to why you cannot remain at this address would be valuable.

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Max. file size: 50 MB.

Proof of income or disability assistance (required for all household members aged 19+)

If receiving income assistance or disability assistance from Advanced Education, Skills and Labour NL: copy of cheque stub or confirmation of monthly assistance.
If employed: proof of current gross monthly income (last three consecutive cheque stubs or letter from employer).
Copies of cheque stubs, bank statements showing direct deposit of pensions, or other confirmation of income for any other income source.

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Max. file size: 50 MB.

Additional Documents (If Applicable)

Copy of Notice to End Tenancy (if you answered Yes to Question 7c)

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Max. file size: 100 MB.

Supporting Documents

Upload Documents/Images Below

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Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 50 MB, Max. files: 5.

Optional: Supplemental Application Information

only needsto be completed if you wish to receive extra consideration for:

Homelessness or risk of homelessness;
Health Condition affected by current housing;
Being at risk of being separated from children due to an inadequate housing assessment; or
Fleeing abuse or violence.

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 100 MB.

I/We declare:*

This is my/our application; and

All the information in it is correct and complete to the best of my/our knowledge.

I/We permit*

The Nunatsiavut Housing Commission to make any inquiries that are necessary to verify the information given in this application;

Any person, corporation or social agency to release to the Nunatsiavut Housing Commission any information pertinent to the assessment of my/our application;

Members of the Nunatsiavut Housing Commission to receive and exchange with credit bureaus and my/our previous landlords’ credit and other tenancy information about me/us, to be used in the decision-making process to provide me/us with housing;

The Department of Advanced Education, Skills and Labour NL to release information to the Nunatsiavut Housing Commission regarding my/our income.

I/We understand*

That this application is not an agreement on the part of The Nunatsiavut Housing Commission or its members to provide me/us with housing;

That if I/we are being considered for an available unit, the Nunatsiavut Housing Commission will gather additional information in order to assess my/our ability to uphold the obligations of a tenancy agreement and it is my/our responsibility to provide or cause to be provided information requested to assist with this assessment;

That it is my/our responsibility to tell the Nunatsiavut Housing Commission of any changes to the information given in this application and to provide any supporting documents required;

That false information given by me/us may result in my/our application being cancelled from consideration;

That if I/we have deliberately worsened my/our current housing situation (e.g., terminated a tenancy for no reason) that my/our application may not be accepted or my/our current living situation may not be taken into consideration.

This application must be signed by all household members aged 19 and older.

Applicant’s Name	Date	Actions

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Affordable Rental Housing Application Form