OTTAWA COMMUNITY HOUSING

Application for Market Rental Accommodation

Complete and mail or drop-off at the address below:

Ottawa Community Housing, Program Development Division
39 Auriga Drive, Ottawa, ON K2E 7Y8 Tel: 731-7223 ext. 309

PLEASE PRINT Disponible en français

IMPORTANT : PLEASE NOTE OCH RENTS BY HOUSING TYPE ON PAGE 2

APPLICANT
Last Name First Name

Street Number Street Name Apartment No. City

Postal Code S.I.N. (optional) Home Telephone Work Telephone

Ext.
Are you allowed to take personal calls at work? If NO, Person to Contact Telephone Number

Yes No
Language Do you require an interpreter? If YES, Person to Contact Telephone Number

Yes No

CO - APPLICANT
Last Name First Name

Street Number Street Name Apartment No. City

Postal Code S.I.N. (optional) Home Telephone Work Telephone

Ext.
Are you allowed to take personal calls at work? If NO, Person to Contact Telephone Number

Yes No
Language Do you require an interpreter? If YES, Person to Contact Telephone Number

Yes No

HOUSEHOLD INFORMATION

Please provide the following information for ALL persons who will live in the accommodation applied for. This
includes yourself, the co-applicant, children and / or other persons. This section must be completed. Include ALL
income.

NAME RELATIONSHIP TO DATE OF BIRTH SEX SOURCE OF INCOME GROSS MONTHLY

APPLICANT Y/M/D M / F INCOME $

Is a baby expected? Date Expected

TOTAL $
Yes No

ASSETS

Do you have savings or assets of more than $500.00? (E.G., bank accounts, RRSP's, GIC's, bonds, land, etc.)

Yes No
 PRESENT ACCOM MODATION
How much do you now pay each month for: How long have you lived at your present address?
Rent $_________________
Landlord's Name: Telephone:
Heat $_________________
Hydro $_________________
Parking $_________________
TOTAL $__ ______________

If you have lived at your present Previous Address:

address for less than one year,
please complete the following. Landlord's Name: Telephone:

Have you EVER been a tenant with Address

Ottawa Community Housing Corporation Yes
or lived in any other non-profit housing?
If YES, indicate the address and dates No
you resided there. Date - From Date - To

PREFERRED AC COM MODATION

I would consider: Rooming House (furnished) Bachelor Apartment No. of Bedrooms Required

Townhouse Senior Apartment (60+)

OCH MARKET RENTS BY HOUSING TYPE

Following are approximate rent ranges for market units. For some townhouse units, costs for heat and hydro are in
addition to the market rents range indicated.
Rooming House from $320 to $330 Apartments Townhouses
1 bed apartment from $500 to $790 1 bed townhouse from $720 to $820
Bachelor from $470 to $595 2 bed apartment from $660 to $850 2 bed townhouse from $675 to $900
3 bed apartment from $745 to $1,075 3 bed townhouse from $780 to $955
4 bed apartment from $1,040 to $1,095 4 bed townhouse from $905 to $990
Please indicate the location or area in the City of Ottawa you wish to be Is there a specific neighbourhood you would like to
considered for (and number in order of preference, if more than one.) be considered for?

East West South Central

Do you own a vehicle(s) and require parking? No. of spaces When would you like housing with Ottawa
Community Housing Corporation?
Yes No

SPECIAL NEEDS
Do you or any member of your household have special requirements which we should be aware of, such as:

Wheelchair Accessible Housing No Stairs Other (please specify)

ALTERNATE CONTACT
PERSON TO CONTACT IF REQUIRED, OR IF WE ARE UNABLE TO REACH YOU
(i.e., Family Member, Social Worker, etc.)
Name: Address: Telephone:

DECLARATION AND CONSENT

1. I / We certify that the information provided on this form is true and complete.

2. I / We understand that a credit verification may be done regarding my application for rental housing with Ottawa
Community Housing.

3. I / We authorize Ottawa Community Housing Corporation to make any enquiries it deems necessary to verify the
above facts and I / we authorize any person, corporation or any social agency having knowledge of any such required
information to release the information to Ottawa Community Housing Corporation.

4. I /We give my/ our consent and authorization for Ottawa Community Housing Corporation to release and disclose
information collected, or on this form, to any social agency or to another provider of social housing.

5. I /We understand that this application does not constitute an agreement on the part of Ottawa Community Housing
Corporation or its agent to provide me/ us with rental accommodation.

6. The Tenant Protection Act (Section 62 (2)) allows non-profit landlords to evict tenants who have "knowingly and
materially misrepresented" information about the income of household members. I / We understand that this applies
to any Ottawa Community Housing Corporation tenancy which may be offered based on the information I / we have
given on this form.
Date Applicant's Signature Co-Applicant's Signature