A few reminders before completing the application:

  • Only completed applications with an attached “option C” printout will be accepted. This “Option C” printout can be obtained from Canada Revenue Agency by calling 1-800-959-8281 and can be uploaded as a PDF.

  • If you have any special needs (accessibility, medical, etc.) please attach a written letter from the appropriate professional (physician, social worker, etc.).

  • If AES is making rental payments on your behalf, please ensure that your AES file number is filled in the first section of the form.

  • Exploits Valley YMCA is subject to the Access to Information and Protection Privacy Act. Applicants/ clients have a right of access to the existence, use and dis- closure of their personal information.

Complete the Application

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Applicant Information

Title *
Gender *
Martial Status *
Aboriginal *

Where can you be contacted?

Proxy Contact

You give consent to the following person to make enquiries or act on behalf of you regarding this application.

Household Occupants

Only list occupants that will be living with you and only list dependants for whom you have joint or sole custody.

If more than four household occupants, please add additional members under the "additional household occupants" section. 

First Occupant (Co-Applicant)

Relationship to Applicant
Marital Status

Second Occupant

Relationship to Applicant
Marital Status

Third Occupant

Relationship to Applicant
Marital Status

Fourth Occupant

Relationship to Applicant
Marital Status
Is anyone in the household expecting a child (affects bedroom requirements)?

Current Housing

What are your present accommodations? *
Currently, I live in: *
Do you owe money to a current/past landlord? *
Do you owe money to a power utility company? *

Income Information

You must attach a copy of the last “Option C” printout for each household member 18 years or older. This “Option C” printout can be obtained from Canada Revenue Agency by calling 1-800-959-8281.

Previous Assistance

Have you ever received the following from Exploits Valley YMCA or NL Housing?

Housing Preferences and Choices

Do you or anyone in your household smoke? *
Do you or anyone in your household own a pet? *
Does anyone in the household have a disability or mobility problem? *

If yes, please provide additional information on the nature of the problem in the "additional information" section. 

Does anyone in the household need home support services? *

If yes, please provide additional information on the nature of the problem in the "additional information" section. 

Declaration

I/We acknowledge the following: *

Additional Information

Please provide additional information for the following:

  • Information regarding a disability or mobility problem
  • Information regarding a need for home support services
  • Medical condition
  • Other circumstances which affect your housing requirement

Additional Household Occupants

Fifth Occupant

Relationship to Applicant
Marital Status

Sixth Occupant

Relationship to Applicant
Marital Status

Seventh Occupant

Relationship to Applicant
Marital Status

Eighth Occupant

Relationship to Applicant
Marital Status