Citaapi Mahtii Hosts Application Support Day for New Housing and BC Housing Programs
on Friday, November 21st, from 10 a.m. to 4 p.m.

Rental Application Form

Complete the form below or

Click here to download a printable version of this form

Step 1 of 8

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This field is for validation purposes and should be left unchanged.

Full Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Year

Month

Day

Current Address(Required)

Street Address Address Line 2 City Province Postal Code

Are you Ahousaht?(Required)

Yes

Are you registered with BC Housing?(Required)

Yes

If no, what First Nation are you associated with?

If yes provide your BC Housing Number

Rental Preferences

Desired Move In Date(Required)

Year

Month

Day

Do you own a vehicle?(Required)

Yes

Do you have mobility issues?(Required)

Yes

If yes, describe

Suite Type(Required)

Studio

1 Bedroom

2 Bedroom

3 Bedroom

4 Bedroom

Tenant insurance is required. Do you anticipate any difficulty obtaining renter’s insurance?(Required)

Yes

If you have renters’ insurance list the provider

Additional Occupants

Please list the names and ages of all individuals who will reside in the unit. If any children are under shared custody, indicate the percentage of time they will be in your care during a standard month.

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Current & Past Landlords

List every address you have lived in the past 5 years with no gaps.

Landlord Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Duration of Tenancy(Required)

Reason for Wanting to Leave(Required)

Rent Amount(Required)

Have you received legal notice to end tenancy?(Required)

If yes, we will require a copy of notice to end tenancy form.

Yes

2nd Landlord's Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Duration of Tenancy

Reason for Wanting to Leave

Rent Amount

Have you received legal notice to end tenancy?

If yes, we will require a copy of notice to end tenancy form.

Yes

References

Do not include family members.

Name(Required)

First Last

Phone(Required)

Relationship(Required)

Name(Required)

First Last

Phone(Required)

Relationship(Required)

Income & Housing Assistance

Current monthly household income(Required)

Applying for(Required)

Market Rent

Rent Geared to Income (RGI)

Deep Subsidy

Source of Income(Required)

Employment

Social Assistance

Disability

Other

Employment Information

If employed. Include everyone in the household with income.

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Consent & Declaration

I declare that the information provided is true and complete. I authorize verification of any information given in this application, including income and references.

Initial below if you agree with the statement above.(Required)

CAPTCHA

Step 1 of 8

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Comments

This field is for validation purposes and should be left unchanged.

Full Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Year

Month

Day

Current Address(Required)

Street Address Address Line 2 City Province Postal Code

Are you Ahousaht?(Required)

Yes

Are you registered with BC Housing?(Required)

Yes

If no, what First Nation are you associated with?

If yes provide your BC Housing Number

Rental Preferences

Desired Move In Date(Required)

Year

Month

Day

Do you own a vehicle?(Required)

Yes

Do you have mobility issues?(Required)

Yes

If yes, describe

Suite Type(Required)

Studio

1 Bedroom

2 Bedroom

3 Bedroom

4 Bedroom

Tenant insurance is required. Do you anticipate any difficulty obtaining renter’s insurance?(Required)

Yes

If you have renters’ insurance list the provider

Additional Occupants

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Name

First Last

Age

Please enter a number from 1 to 100.

Relation

% of time they will occupy the unit/month

Current & Past Landlords

List every address you have lived in the past 5 years with no gaps.

Landlord Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Duration of Tenancy(Required)

Reason for Wanting to Leave(Required)

Rent Amount(Required)

Have you received legal notice to end tenancy?(Required)

If yes, we will require a copy of notice to end tenancy form.

Yes

2nd Landlord's Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Duration of Tenancy

Reason for Wanting to Leave

Rent Amount

Have you received legal notice to end tenancy?

If yes, we will require a copy of notice to end tenancy form.

Yes

References

Do not include family members.

Name(Required)

First Last

Phone(Required)

Relationship(Required)

Name(Required)

First Last

Phone(Required)

Relationship(Required)

Income & Housing Assistance

Current monthly household income(Required)

Applying for(Required)

Market Rent

Rent Geared to Income (RGI)

Deep Subsidy

Source of Income(Required)

Employment

Social Assistance

Disability

Other

Employment Information

If employed. Include everyone in the household with income.

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Employer's/Company Name

Position

Monthly Income

How long have you worked there?

Hours per week

Consent & Declaration

I declare that the information provided is true and complete. I authorize verification of any information given in this application, including income and references.

Initial below if you agree with the statement above.(Required)

CAPTCHA

Rental Application Form

Complete the form below or

Rental Preferences

Additional Occupants

Current & Past Landlords

References

Income & Housing Assistance

Employment Information

Consent & Declaration

Rental Preferences

Additional Occupants

Current & Past Landlords

References

Income & Housing Assistance

Employment Information

Consent & Declaration

Citaapi Mahtii Housing Society sits at the table of partners with the Port Alberni Action Committee and the Alberni Clayoquaht Health Network.

Building healthy partnerships in the Valley.