Test Form

NOTE: We recommend for Housing Applications for Wahgoshig First Nation to be submitted every two (2) years. The two-year timeline begins from date of application. All applications older than two (2) years old will not be considered and will be destroyed.

SECTION 1: Applicant’s Information

Full Name of Applicant

First Nation/ Indian Band:

Indian Status #:

Home Address of Applicant:

Mailing Address: (If different from home address.)

Marital Status:

Phone #:

SECTION 2: Applicant’s Source of Income

Employed? YesNo

Employment Status Full-timePart-time

Name of Employer:

Contact #:

Other Income? Social AssistanceDisability BenefitsEmployment BenefitsOld Age SecurityPost-Secondary SponsorshipSelf-employed

Other:

SECTION 3: Spouse’s Source of Income

Full Name of Spouse:

Employed? YesNo

Employment Status Full-timePart-time

Name of Employer:

Contact #:

Other Income? Social AssistanceDisability BenefitsEmployment BenefitsOld Age SecurityPost-Secondary SponsorshipSelf-employed

Other:

SECTION 4: Type of Housing Needed

Housing Needed Bachelor Unit2 Bedroom Unit3 Bedroom Unit4 Bedroom Unit

Any accessibility requirements for disabilities? YesNo

SECTION 5: List of Dependents

First DependentName Relation to Dependent Age

Second DependentName Relation to Dependent Age

Third DependentName Relation to Dependent Age

Fourth DependentName Relation to Dependent Age

SECTION 6: Letter From Applicant

Is a written letter to request for housing available? YesNo

If no, when will letter be provided?

SECTION 7: References

Please provide the names and contact information for three (3) references to include with your application. Do not provide the names and contact information of family members.

First ReferenceName Type of Relationship Phone Number or Email Address

Second ReferenceName Type of Relationship Phone Number or Email Address

Third ReferenceName Type of Relationship Phone Number or Email Address

Fourth ReferenceName Type of Relationship Phone Number or Email Address

DECLARATION

Z/we, the undersigned, hereby certify that the information given for this application is, to the best of my/our knowledge, true and I/we further recognize any false information given may result in the retraction of an offer for a housing unit from Wahgoshig First Nation,
I agree