BC Housing Rent Supplement Application

Rent Supplement Information

THE RENT SUPPLEMENTS ARE FUNDED BY BC HOUSING AND ARE PROVIDED AS A FLEXIBLE, TIMELY OPTION FOR INDIVIDUALS AND FAMILIES WHO ARE EXPERIENCING HOMELESSNESS (OR AT RISK OF HOMELESSNESS) WHO DO NOT HAVE SUFFICIENT FUNDS TO EITHER FIND OR MAINTAIN APPROPRIATE HOUSING.
THE RENT SUPPLEMENTS ARE INTENDED TO PROVIDE A TOP UP TO RENT OR PROVIDE “BRIDGE” FUNDS THAT WILL HELP HOUSE PEOPLE QUICKLY (OR RESPOND PRIOR TO AN EVICTION).
EVERY EFFORT WILL BE MADE TO ENSURE TIMELINESS OF RESPONSE TO THIS PROCESS.

Eligibility Criteria:

HOMELESS (ABSOLUTE OR RELATIVE) OR AT-RISK OF HOMELESSNESS
UNABLE TO ACCESS CRISIS FUNDING/GRANTS ELSEWHERE (I.E. MSD, I.A)
WILLINGNESS TO ACCESS SUPPORT FROM COMMUNITY AGENCY WHERE APPROPRIATE TO ADDRESS ANY OUTSTANDING BARRIERS TO FINDING AND MAINTAINING HOUSING

There Are Two Types Of Supplements:

ONE-TIME CRISIS
MONTHLY RENT

Where To Apply:

NOW CANADA – HOUSING OUTREACH

FEMALE, IDENTIFYING AS ONE OF THE FOLLOWING:

VICTIM OF VIOLENCE
LEAVING CORRECTIONAL SYSTEM
LEAVING HEALTH CARE SYSTEM
YOUTH AT RISK
ABORIGINAL

2970 TUTT ST, KELOWNA BC, V1Y 8Z5
PHONE: (250) 763-3876
FAX: (250) 868-3876
EMAIL: [email protected]
MORE INFORMATION AND LINKS TO APPLICATIONS @ WWW.NOWCANADA.CA

KI-LOW-NA FRIENDSHIP SOCIETY – OUTREACH

IDENTIFIES AS ABORIGINAL

442 LEON AVENUE, KELOWNA, BC, V1Y 6J3
PHONE: (250) 763-4905
FAX: (250) 861-5514
EMAIL: Please call for contact information

FOUNDRY KELOWNA – OPERATED BY CMHA KELOWNA

YOUTH AT RISK (18-25)

504 SUTHERLAND AVE, KELOWNA BC, V1Y 5X1
PHONE: (250) 861-3644
FAX: (250)-763-4827
EMAIL: [email protected]

CMHA KELOWNA – HOUSING & HOMELESSNESS SERVICES

504 SUTHERLAND AVE, KELOWNA BC, V1Y 5X1
PHONE: (250) 861-3644
FAX: (250)-763-4827
EMAIL: [email protected]

Application Process: Email Appropriate Agency for Application (And/Or Info)

COMPLETE RENT SUPPLEMENT APPLICATION
ATTACH PROOF OF RENT (LEASE AGREEMENT, RENT RECEIPT) AND MOST RECENT 60-DAYS BANK STATEMENT. IF NOT ATTACHED, IT WILL BE REQUESTED BY THE FACILITATOR AT A LATER DATE.
FAX COMPLETED FORM TO APPROPRIATE ORGANIZATION – CMHA, NOW CANADA, OR KFS
ORGANIZATION WILL FOLLOW-UP WITH REFERRAL SOURCE WITHIN ONE WEEK OF RECEIPT OF APPLICATION TO CONFIRM ELIGIBILITY AND APPROPRIATENESS OF APPLICATION

Conditions of Application

IF CLIENTS’ RENT IS PAID DIRECTLY FROM THE MINISTRY OF SOCIAL DEVELOPMENT, REFERRING AGENCY IS RESPONSIBLE FOR ALL COMMUNICATION WITH MSD REGARDING ANY CHANGES IN STATUS OF CLIENT
RENT SUPPLEMENT CHEQUES WILL ONLY BE PAID DIRECTLY TO THE LANDLORD OR VENDOR AND A RECEIPT IS REQUIRED
THERE WILL BE A 6 & 12 MONTH FOLLOW-UP CALL
ALL RELEVANT INFORMATION IS RECORDED IN A DATABASE REPORTING ALL THE ACTIVITIES TO BC HOUSING
BC HOUSING CLIENT CONSENT AND AUTHORIZATION MUST BE SIGNED FOR RENTAL SUPPLEMENT CHEQUE TO BE RELEASED
INCOMPLETE APPLICATIONS MAY DELAY PROCESSING TIMES

Supplement Request

Date of Request:*

Referring Agent:

Organization:

Phone Number:

Email:

Client Information

First & Middle Name:*

Last Name:*

Phone Number:*

Birth Date:*

Street Address:*

Apt, Suite, Bldg. (optional)

City:*

Province*

Postal Code*

Country*

Is this a new tenancy?*YesNo

Tenancy Start Date:*

Monthly Rental Amount:*

Gender:*MaleFemaleTransgender-FemaleTransgender-MaleOtherTwo-SpiritNon-binary

Aboriginal:*YesNo

Family Status:*SingleCoupleFamily (If yes, please fill in next entry)

Family Status (If family, please enter total number of individuals):

Monthly Income Amount:*

Source of Income:*NONEEMPLOYMENTEMPLOYMENT INSURANCE (EI)BASIC INCOME ASSISTANCE (IA)CANADA PENSION PLAN (CPP)CANADA PENSION PLAN – DISABILITY (CPP-D)OLD AGE SECURITY (OAS)GUARANTEED INCOME SUPPLEMENT (GIS)SAFERBCH RENTAL ASSISTANCE PROGRAM (RAP)CHILD TAX BENEFITINCOME ASSISTANCE - PERSONS WITH PERSISTANT MULTIPLE BARRIERS (PPMB)INCOME ASSISTANCE – PERSONS WITH DISABILTY (PWD)

OTHER SOURCE OF INCOME: (If OTHER - you MUST provide details here for your application to be considered)*

Have you received any rent supplement funding before?*YesNo

If yes (previous question), from where?CMHAKFSNow CanadaOther (If yes, please include more information in the field below):

Source of previous rent supplement funding: If OTHER, please provide details here

Previous rent supplement funding: On which date?

Check Those That Apply For Client

SelectIDENTIFIES AS ABORIGINALVICTIM OF VIOLENCELEAVING CORRECTIONAL SYSTEMLEAVING HEALTH CARE SYSTEMYOUTH AT RISKOTHER (If yes, please include more information in the field below)

Check those that apply: (If OTHER, please provide details here)

Type of Supplement Requested

Select*ONE-TIME CRISISMONTHLY RENT SUPPLEMENT (CONSIDERATION FOR EXTENSIONS WILL BE DETERMINED UPON REVIEW)

Please Describe

The situation & need pertaining to rent supplement request:*

How you plan to stabilize your housing situation after the supplement. (Ex: Income assistance will be approved so I can pay the rent)*

Has the client attempted to access funds elsewhere? Please explain:*

Landlord/ Billing Information

First & Middle Name:*

Last Name:*

Street Address:*

Apt, Suite, Bldg. (optional)

City:*

State / Province / Region*

Postal Code*

Country*

Phone Number:*

Rental Name (Hotel/ Building)*

Description of Rental*APARTMENT IN MARKET HOUSINGHOTEL/ ROOMING HOUSEROOM IN A HOUSESECONDARY SUITERECOVERY/TREATMENTCAMPSITESOCIAL HOUSING/SUPPORTED HOUSINGOTHER (If yes, please include more information in the field below)

Description of Rental: (If OTHER, please provide details here)

Other Supports Involved

Probation/ Parole

Mental Health Support

Alcohol & Drug Support

Family Physician

Psychiatrist

Other

Client Consent & Authorization

Service Provider Name:*

is seeking your consent for the following purposes:

Your consent to collect your personal information into the computer system we use.

This will help us meet your needs and connect you with appropriate support services.

Your consent to share your personal information with our funder, BC Housing.

BC Housing is responsible for hosting the computer system we use to help manage our services.
BC Housing will use the information in the system, at an aggregate level, to help improve services and funding.

Your consent to migrate your personal information from the current computer system we use to the new one we will be using in the future.

Your consent to share your personal information with other service providers using the system.

The new computer system we will be using in the future will allow for some data sharing.
If you require services from another service provider, authorized staff will be able to access your personal information to improve the consistency and quality of services provided to you.

If you are accompanied by your children who are under the age of 19, we will also need to collect personal information about them. This is to ensure that information about families using services is recorded accurately.

Your consent to share limited non-identifying information with Employment and Social Development Canada.

They will use this data to help create a national picture of the scope of homelessness in Canada.

If you choose not to sign this document, services will still be provided to you, except in regard to rent supplements. If your service provider has rent supplements, you will need to sign this consent form to be considered for and to receive a rent supplement (for accounting purposes).

Digital Signature

Signature of Client to Indicate ConsentI consent to the release of this information

Name of Client:*

Date of Consent:*

Attach Documents

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