Housing - Waddington Application

  • Applicants
  • Residency History
  • Current Housing
  • Reason for Move
  • Complete

This application form is designed to collect specific information from applicants seeking affordable housing. Nanaimo Youth Services Association will use this information to determine your eligibility for housing. Please answer all questions. For help in completing this form, please ask your referring worker or call us at (250) 753 - 3212 and we will be happy to answer any of your questions.

A. Applicants (Asking for housing)
Gender
Preferred Gender Pronouns
Wheelchair Requirements
Permission to share your contact information with HIFIS
Permission to share your contact information with the Homeless Individuals and Families Information System (HIFIS) for Nanaimo.
Do you have any dependents
B. Housing Composition

If applicable list your dependent

Gender
Wheelchair Requirements
Do you expect the number of people in your family to change in the next 12 months? (pregnancy, family joining or leaving)