If you require clarification or assistance, call our office at 519-371-6776, extension 101 and speak with Rachelle or email info@habitatgreybruce.ca Family Information for Expression of InterestName of Applicant *Name of Co-applicant Address *Unit / Apt. City / Town *Postal Number of years at address Email Re-Enter Email Home Phone Work Phone Cell Phone Number of children living at home Ages of Children EmploymentApplicants Job / Occupation Co-Applicants Job / Occupation Name of Employer Name of Employer Number of years working there Number of years working there Employers Phone Employers Phone Current Accommodation Describe your present home (number of bedrooms, condition etc.) and explain why your family needs a new home. List the town / city where you prefer to live. You may list more than one. Household IncomeMonthly Gross (before deductions) Income from EmploymentApplicant Co-applicant Other Adult 18+ Employment Insurance (E I)Applicant Co-applicant Other Adult 18+ Contracted Child Support ReceivedApplicant Co-applicant Other Adult 18+ Contracted Spousal Support ReceivedApplicant Co-applicant Other Adult 18+ Child Tax BenefitsApplicant Co-applicant Other Adult 18+ Ontario Disability SupportApplicant Co-applicant Other Adult 18+ CPP or Other Pension IncomeApplicant Co-applicant Other Adult 18+ Other IncomeApplicant Co-applicant Other Adult 18+ Debt and AssetsCredit Card BalancesApplicant Co-applicant Other Adult 18+ Total Loans and Other DebtsApplicant Co-applicant Other Adult 18+ Total AssetsApplicant Co-applicant Other Adult 18+ Have you declared or been discharged from bankruptcy within the past 3 years? (required answer) *YesNo Other List any additional comments about the information you have provided. VerificationPlease enter any two digits *Example: 12 By submitting this form you certify that you have answered all of the questions truthfully and to the best of your knowledge.This box is for spam protection - please leave it blank:
