Rental Application
Applicant'sFull Name:
______
FirstName Initial Surname
malefemale
______
Date ofBirth:mm/dd/yyyy
Pleasechecktheappropriatebox:
FirstNation Inuit Métis Non-Status Non-Native
Gross Income/month: $
SocialInsuranceNumber (optional): / H phone:( ) - ______
W phone:( ) - ___
C phone: ( ) - ___
Email address:
------
AddtoMNO email list?NO YES
IfApplicantisunder 18,is theApplicant16 yearsofage orolder,andabletoliveindependently?NO YES
CurrentAddress:
Co-applicant(if any):
FirstNameInitial Surname
malefemale
______
Date ofBirth:mm/dd/yyyy
Pleasechecktheappropriatebox:
FirstNation Inuit Métis Non-Status Non-Native
Gross Income/month: $
SocialInsuranceNumber (optional): ______/ H Phone#:( )_ - ____
WPhone#:( )_ - ______
C Phone#: ( )_ _ - ______
Email address:
______
AddtoMNO email list?NO YES
CurrentAddress (leave blank if same as Applicant):
UNITSIZEREQUESTED: 1Bedroom2Bedroom3Bedroom4Bedroom
Areyou willingtorelocatetoanothercommunity/region? NO YES
If yes, where(see attached location sheets):
DateRequired:
______
Question#1HouseholdComposition
Full Name of Other Household Member(s) / Date of Birth
D/M/YYYY / M/F / Relationship to Applicant (daughter, son,partner, etc) / Income/month / Dependent?
YES/NO / Foreachapplicant,pleasecheckthe
appropriatecolumn
FN / Métis / Inuit / Non- Status / Non- Native
1 / $
2 / $
3 / $
4 / $
5 / $
6 / $
7 / $
8 / $
Question#2HouseholdEmploymentIncomeInformation(includeanyspousal or childsupportreceived)
HouseholdMember:Applicant# / Spousal orchildsupport $ / /month
Nameaddressof Employer/SourcesofIncome: / Howlong:
Phone#:()- / Rate ofPay: / Total Hours/Week:
HouseholdMember:Applicant# / Spousal orchildsupport $ / /month
Nameaddressof Employer/SourcesofIncome: / Howlong:
Phone#:()- / Rate ofPay: / Total Hours/Week:
HouseholdMember:Applicant# / Spousal orchildsupport $ / /month
Nameaddressof Employer/SourcesofIncome: / Howlong:
Phone#:()- / Rate ofPay: / Total Hours/Week:
Question#3OtherHouseholdIncome:IfonSocial Support,selectall thatapply(ifnotapplicable,gotoQuestion#4)
ODSPOW Canada Child Benefit (CCB)  CPP  OldAgeSecurity (OAS) 
GuaranteedIncomeSupplement
MonthlyTotal, exceptforCCB:$
CanadaChildTaxBenefit (CCB) monthlyamount:$
Spousal orChildSupportmonthlyamount:$
Educationliving allowance(i.e. OSAP,FN EducationLiving Allowance, ETC.):$
Other Income Source(s)monthly amount: $ Specify type of income:
Question#4 Financial Obligations
Areyouaware ofanyjudgments,writs,executionsorpending courtactions: NO YES
Areyoucurrentlyinarrears and/orhave outstanding debtwithaSocial Housing provider,oranylandlord?
NOYES, indicate payments below
Payments to / Howmuch/how often(monthly,weekly)
$
$
$
Question#5DetailsonPresentAccommodations(IfwithoutaccommodationselectN/Aandgoto#6)
Atpresent,doyou RENT or OWN N/A / Ifrental,areyoucurrentlywith a Social Housing provider?
NOYES
Living in:HouseApartmentOther
Briefly describeyour currentaccommodations:
Current monthlyrent:$ / Does therentinclude heat,hydroorwaterYESNO
Ifnotincluded with rent,howmuchmonthlyfor: / Heat
$ / Hydro
$ / Water
$
Question#6 Additional Information
Numberandtype ofpets:
Smoker(s)YESNO
Question#7 ResidenceHistory
Please provideyourresidence history(addresses)for the pastfiveyears. Ifyou
havemorethanthespacesallowfor,pleaseattachthoseaddressesseparately, including theinformationrequestedatright. / Forhow
long? / Reasonforleaving
(if currentresidence,your reasonforwantingtoleave)
1. CurrentResidence(if any)
2.
3.
4.
5.
Question#8 How didyouhearaboutthe RNH program?
Question#9 Aretherespecial circumstances thatshouldbeconsideredbyMNO?
TheRural and Native Housingprogram(RNH)wasdesigned to assist eligible families in rural areas to have access to adequate, suitable and affordable housing; tenantselection is based on RNH Guidelines as set out by Ontario Aboriginal Housing Services. Tenants are selected on a priority basis, that is, those with the greatest need will be housed first.Those prioritiesare:
1. Families/singleparentfamilies/seniors/individualswhohavehadnootheralternativebuttoturntoemergency shelterstoescapeviolenceoranyothertypeofphysicalormentalgriefbytheirspouses,orpartners,orotherfamily memberswithwhomtheyresideandfromwhomtheyintendtoseparate permanently.
2. Families/singleparentfamilies/seniors/individualsthatarewithoutortobewithouthousingbynofaultoftheirown, familieswhoseresidencehasbeendestroyedandhavenoplacetolive, landlordswhohavesoldthepropertyand haveterminatedthefamily’stenancy,individualswhohavebeenreleasedfromahospitalorfacilityand cannot returntotheirformerresidence,familiesatriskoflosingcustodyofchildrenthroughlackofsafeaffordablehousing.
3. Families/singleparent families/seniors/individualsthat havehadnoalternativebuttoseparateandseekliving accommodationswithotherfamilymembersbecause of thelack ofaffordable housing.
4. Families/single parentfamilies/seniors/individuals thatarecurrentlyliving withhazardous conditionssuchas; inadequatekitchenfacilities,inadequate bathroomfacilities,inadequaterecreational spacefor children, inadequate ornoelectrical wiring,inadequate orunsafe heating facilities,otheridentifiedrisks,or the needfor specifichousing requirementse.g. wheel chairaccess,groundfloor.
Arethereany priorities thatapplytoyou/yourhousehold?Pleaseexplain:
REFERENCES
BankReference(Nameof Bank) / Address
ChequingAccount# / SavingsAccount#
CreditReference(Nameof Credit Card Issuer) / CreditAccount#
Address / Phone#
PersonalReference / Address / Phone#
LOANS
Institution / Address / MonthlyPmt. / Balance
1.
2.
3.
VEHICLES
Make/Model / Year/Colour / LicencePlateNumber / Province
1.
2.
3.
Question#10 Incaseofemergency:Pleasegivecontactdetailsforthreefamilymembers
Name / Address / Phone#withareacode

I/weagreethat ifmyapplicationisacceptedbutthe tenant whocurrentlyoccupiesthesubjectpremisesfailsorrefusesto vacatethepremisespriortotheintendedcommencementofmytenancy,thenmyrighttotheproposedtenancyshallcome toanend,withoutanyfurtherclaimagainstthelandlord.

I/weagreethatifmyapplicationisaccepted,andthetermsandconditionsof theResidentialTenancyAgreementarewithin the parametersof theResidential TenanciesAct,I/wewill signtheResidentialTenancyAgreementwithOAHS,andI/wewill complywithall termsandconditions containedintheResidential TenancyAgreement.

I/weconsenttopermittingthelandlordtocheckandconfirmmycredithistory,creditreferences,rentalhistory,employment historyandincomeamount,andtoexchangeany informationtoverify theaboveaspermittedundertheOntarioHuman RightsCode.

I/weconsenttothesharing ofmyinformationwithyourpartners.

I/weagreethatifmyapplicationisapproved,butthefirstmonth’srentisnotreceivedinfullontheagreed-tomoveindate, orIdonot signtheResidentialTenancyAgreement, thenthelandlordshallnot beobligatedtorent thepremisestothe applicant.

The undersignedagree(s) thatall information givenis tobelegal andtrue.Notcomplying (falsifyinginformation)isgrounds forimmediateevictionshouldthisapplicationbeapproved.

I/weherebycertifythattheaboveinformation istrueandcompleteandthatI/wehavenotwithheld anyinformation relevanttothisapplication.ItisalsounderstoodthatOAHSreservestherighttorejectthisapplicationattheirsolediscretion. I/we havereadandunderstandtheseconditions.

ApplicantSignatureDateCo-ApplicantSignatureDate

GuarantorSignature(ifrequired)Please printnameDate

Pleasecomplete application in fullandfaxto1-807-626-9030ormail to:

Infinity Property Services

An Agency of the Métis Nation of Ontario

226 May St. S.

Thunder Bay, ON P7E 1B4

Ifyourequirefurtherinformationorassistancewiththisapplication,pleasecall Toll Free 1-800-891-5882.

PREFERRED HOUSING LOCATION

THIS FORM MUST BE INCLUDED WITH YOUR APPLICATION

Please identify which RNH communities interest you and sign page 2:

SIMCOE REGION □ I am interested in any unit in the Simcoe Region

Barrie Area

  • Angus
/
  • Elmvale

  • Phelpston
/
  • Stayner

  • No preference within Barrie Area

Couchinching Area

  • Cumberland Beach
/
  • Sebright
/
  • Ramara

  • Orillia
/
  • Warminister
/
  • Washago

  • No preference within Couchinching Area

Georgian Bay Area

  • Victoria Harbour
/
  • Honey Harbour
/
  • Port McNicoll

  • Midland (rural)
/
  • Coldwater
/
  • Waubaushene

  • Wyevale
/
  • Tiny
/
  • Port Severn

  • Penetanguishene (rural)

  • No preference within Georgian Bay Area

MUSKOKA REGION □ I am interested in any unit in the Muskoka Region

Huntsville Region Area

  • Huntsville (rural)
/
  • Utterson

  • No preference within Huntsville Area

Lake of Bays Area

  • Dorset
/
  • Baysville

  • No preference within Lake of Bays

Bracebridge/Gravenhurst Area

  • Bracebridge (rural)
/
  • Port Carling (PS)

  • Gravenhurst (rural)

  • No preference within Bracebridge/Gravenhurst

PARRY SOUND REGION □ I am interested in any unit in the Parry Sound Region

East Parry Sound

  • Arnstien
/
  • Emsdale
/
  • Port Loring

  • Burk’s Falls
/
  • Katrine
/
  • Sundridge

  • Dunchurch
/
  • Kearney
/
  • Whitney

  • No preference within East Parry Sound

West Parry Sound

  • Mactier
/
  • McDougall
/
  • Pointe au Baril

  • Nobel
/
  • Rosseau
/
  • Sequin

  • No preference within West Parry Sound

YORK REGION □ I am interested in any unit in the York Region

  • Cannington
/
  • Pefferlaw
/
  • Jackson’s Point
/
  • Port Bolster
/
  • Willow Beach

  • No preference within York Region

BRUCE PENNINSULA □ I am interested in any unit in the Bruce Peninsula Region

North Bruce Peninsula

  • Lion’s Head
/
  • Stokes Bay

  • Pike Bay
/
  • Tobermory

  • No preference within North Bruce Peninsula

South Bruce Peninsula

  • Hepworth
/
  • Wiarton
/
  • Shallow Lake

  • Mar
/
  • Miller Lake
/
  • Georgian Bluffs

  • No preference within South Bruce Peninsula

Preferred Housing Locations 1 of 2

GREY/BRUCE REGION □ I am interested in any unit in the Grey Region

Arran-Elderslie

  • Allenford
/
  • Dobbinton
/
  • Tara

  • Chesley
/
  • Paisley

  • No preference within in Arran-Elderslie

Chatsworth

  • Chatsworth
/
  • Desboro

  • No preference within Chatsworth Township

Grey Highlands/Southgate

  • Flesherton
/
  • Dundalk

  • Markdale

  • No preference within Grey Highlands/Southgate

Meaford/Owen Sound Region

  • Bognor
/
  • Owen Sound (rural)

  • Meaford

  • No preference within Meaford/Owen Sound

THUNDER BAY DISTRICT □ I am interested in any unit in the Thunder Bay District

Greenstone

  • Beardmore
/
  • Caramat

  • Jellicoe
/
  • Longlac

  • MacDiarmid
/
  • Nakina

  • No preference within Greenstone Area

Thunder Bay

  • Armstrong
/
  • Conmee
/
  • Dorion

  • Hurkett
/
  • Kakabeka Falls
/
  • Kaministiqua

  • Lybster
/
  • Marathon
/
  • Neebing

  • Nipigon
/
  • O’Connor
/
  • Oliver / Paipoonge

  • Red Rock
/
  • Rossport
/
  • Schreiber

  • South Gillies
/
  • Terrace Bay
/
  • Upsala

  • No preference within Thunder Bay East

ALGOMA DISTRICT

  • Hornepayne
/
  • White River
/
  • No preference within area

KENORA DISTRICT

  • Pickle Lake
/
  • No preference within area

* IMPORTANT:If you have selected an entire District/Region or more than three (3) communities, please identify your top three preferred TOWN/TOWNSHIP/COMMUNITY choices:

1 / 2 / 3

Do you have any comments or special requests?

Applicant Name: / Signature:
Co-Applicant Name: / Signature:

Preferred Housing Locations 2 of 2