Application

BethelPlace-4095

Applicant(s)

Applicant

Applicant Name - (Required)

Date of Birth

Day - (Required)

Month - (Required)

Year - (Required)

Co-Applicant (Please fill out if more than one applicant)

Applicant Name

Date of Birth

Day

Month

Year

Current Living Information

Address - (Required)

Apt. No.

City/Town - (Required)

Province - (Required)

Postal Code - (Required)

Please check one of the following for your present form of accommodation - (Required)

If renter, name of Landlord

Contact Information

Phone - Home - (Required)

Phone - Business:

Phone - Cell:

Email:

Bethel Place Living Arrangements

How soon would like to move in? - (Required)

*It is your responsibility to contact us annually to update your information.

*It is your responsibility to contact us to indicate a readiness to move. We will begin the pre-admission process when you contact us indicating a readiness to move within 12 months.

Type of Suite Requested - (Required)

Do you require parking? - (Required)

*Rent for a parking space is extra. Each apartment is allocated one parking space as available.

Income

Would you like to apply for a rent geared to income or minimum rent? - (Required)

What is your current annual income? - (Required)
Applicant
$

Co-Applicant
$

*Bethel Place will require you to provide a copy of their previous year’s Notice of Assessment at their Pre-Admission assessment before a lease can be signed. Applicants who expect to pay rent geared to income rent or minimum rent for a 1 bedroom must provide a certified copy of your most recent income tax to calculate the rent formula. Call 1-800-959-8281 to request a copy of your income tax assessment, or visit CRA internet website www.canada.ca/en/services/taxes/income-tax

By checking this box, I (We) hereby declare that the information given on this application is correct and/or complete and understand that this application does not constitute an agreement or lease with Bethel Mennonite Care Services, Inc., to provide accommodations. (Required)

Agree

*Bethel Place is committed to protecting your privacy and the confidentiality of your personal information. All information you provide to us shall be kept for the sole purpose of assessing and processing your application for residency.

*It is your responsibility to contact us annually to update your information, including a change in your readiness to move. We will begin the pre-admission process when you contact us indicating a readiness to move within 12 months.

*An assessment meeting is required for all applicants who have indicated a readiness to move. The purpose of the assessment is to provide transparency for communication between Bethel Place and the applicant to help discern housing placement. Family members pr advocates may accompany the applicant. A meeting with the applicant will be scheduled with Administration in order of the original application date and availability of apartments.