Application for Rent-Geared-to-Income (RGI) Housing

Application for Rent-Geared-to-Income (RGI) Housing If you do not complete all sections of this application form or do not attach all the required documents, your application cannot be processed. Your completed application form and attached documents can be mailed or delivered to: Access to Community Housing (HATCH) 690 Dorval, 7 th Floor Oakville, ON L6K X9 APPLICATIONS WILL NOT BE ACCEPTED BY FAX For more information, Dial or visit www.halton.ca/hatch or email hatch@halton.ca.

HATCH APPLICATION CHECKLIST IMPORTANT: *If you do not complete all sections of this application form or do not include citizenship documentation for all household members, HATCH may be required to shred your application without placing you on the wait list. Complete the Check list below: To be Eligible for subsidized housing your household must meet all of the items listed below:.... 5. 6. 7. 8. all sections of the application are complete. page is signed by all household members 6+ years old. You must be able to live independently, and make your own arrangements for support services in order to receive RGI housing. copies of Canadian birth certificates, Canadian passport, landed immigrant, permanent resident card or refugee claimant documents for ALL members of the household are included. No member of the household is currently under a deportation, departure or exclusion order to leave Canada. the Building Selection form is complete (only those 60+ can select buildings from any community type (Senior pg.-8 /Non-senior pg.8-9). are you requesting an additional bedroom for a member of your household where there is a legal custody agreement or visiting rights involving overnight stays? If yes, you must supply a copy of the agreement. No member of the household owes money to any social housing provider. 9. 0. confirmation that payments on arrears to a Social Housing Provider are in good standing (Repayment Schedule) are included. If you own a house or rent any other property, you must agree to sell it or terminate the lease within 80 days of being housed.. No member of the household has been convicted of an offence in relation to rentgeared-to-income assistance or found by a court of law to have misrepresented their income for the purpose of rent-geared-to-income assistance.ve misrepresented their income for the purpose of rent-geared-to-i Forms related to the requests below are available online: IMPORTANT: Visit www.halton.ca/housing to print and complete the form(s) related to the specific request you have selected above and provide to HATCH with this completed application form. Are you requesting a wheelchair accessible unit? Are you requesting an additional bedroom due to an existing medical condition? Are you applying as a victim of domestic violence under the Provincial Special Priority Policy (SPP)?

HATCH Applicant Roles and Responsibilities when applying and once approved: HATCH applicants are required to: Keep contact information in your HATCH application up-to-date. Complete the Annual Update Requirement form each year, in the summer. Enter into a repayment agreement with any social housing provider where you owe money SECTION PRIMARY APPLICANT INFORMATION First Name: Last Name: Middle Name or Initial: Alternate/Maiden Name: Sex: Male Female Other Date of Birth / / MM / DD / YYYY Marital Status: Single Common Law Married Separated Divorced Widowed What is your status in Canada? (attach proof to the application for all household members) Canadian Citizen First Nations (or) Landed Immigrant Refugee Refugee Claimant Applied for Permanent Resident status Sponsored Immigrant *Applicants who have Record of Landing Documents- please provide a copy(s) along with any other proof of status in Canada documentation (Date of arrival to Canada ) MM / DD / YYYY Social Insurance Number:(optional) E-mail: Current Address: Unit #: Box #: City: Province: Postal Code: Home Phone: Cell Phone: Work Phone: Ext: Can we call you at work? Yes No Mailing / safe address, if different from above: c/o: Unit #: Box #: City: Province: Postal Code: Present Landlord: (Name and Address) Landlord Phone #: Monthly Rent: $

SECTION PRIMARY APPLICANT INFORMATION Continued Why do you want to move? Why do you want to move to Region? Have you ever lived in Region? Yes No If yes, why did you leave? If yes, when did you live in Region? Is your current landlord a social housing provider? Yes No Are you currently receiving a rent-geared-to-income subsidy? Yes No Are you receiving any other housing related financial assistance (e.g. rent supplement, housing allowance, etc )? Yes No If yes, please explain: In what city/country did you live one year ago? City: Country: I am able to live independently: Yes No Are you willing to pay market rent? Yes No Spoken language(s): English French Preferred language of correspondence: English French Do you use an interpreter? Yes No Language: Interpreter s Name: Interpreter s Phone #: ( ) Other people we can call if we need to reach you: Name Relationship Agency Home Phone # Other Phone # Do you give us permission to talk about your application with the above people? Yes No Please note that HATCH may discuss any matter about your HATCH application with the individuals listed above. 5

SECTION Primary CO-APPLICANT Applicant Information First Name: Middle Name or Initial: Last Name: Alternate/Maiden Name: Sex: Male Female Other Date of Birth: / / MM / DD / YYYY Marital Status: Single Common Law Married Separated Divorced Widowed What is your status in Canada? (attach proof to the application) Canadian Citizen First Nations (or) Landed Immigrant Refugee Refugee Claimant Applied for Permanent Resident status Sponsored Immigrant *Applicants who have a Record of Landing Document - please provide a copy along with any other proof of status in Canada documentation. (Date of arrival to Canada ) MM / DD / YYYY Social Insurance Number:(optional) E-mail: Current Address: Unit #: Box #: City: Province: Postal Code: Home Phone: Cell Phone: Work Phone: Ext: Can we call you at work? Yes No Present Landlord: Landlord Phone #: Monthly Rent: $ Why do you want to move? Why do you want to move to Region? Have you ever lived in Region? If yes, when did you live in Region? Yes No Is your current landlord a social housing provider? Yes No Are you currently receiving a rent-geared-to-income subsidy? Yes No Are you receiving any other housing benefit (rent supplement, housing allowance, etc.)? Yes No If yes, which benefit? In what city/country did you live one year ago? City: Country: 6

Month Day Year Canadian Citizen First Nations Landed Immigrant Refugee or Refugee Claimant Applied for Permanent Residence SECTION Primary HOUSEHOLD Applicant INFORMATION Information List the names of all adults and children (including yourself) who will live with you in subsidized housing. You must attach proof of your legal status in Canada for all household members. Status in Canada Last Name First Name Relationship to You Sex M F O Date of Birth Social Insurance Number (Optional) self Do you have joint access of the children listed in this application? If yes, please provide documentation. Yes No N/A Name of Child Arrangement Details Shared Custody Visitation Shared Custody Shared Custody Shared Custody Visitation Visitation Visitation 7

SECTION HOUSEHOLD INFORMATION Continued SUPPORT SERVICES UNITS Do you or anyone who plans to live with you require support services In order to live independently? If you answered Yes to the above question select: Yes No The Support Service Building Selections Located on pages pg.7 & pg.9. IMPORTANT: Please provide a copy of one of the following documents for each household member Canadian Birth Certificate (front and back) OR Canadian Citizenship Documents (front and back) Permanent Resident Card (front and back) Refugee Claimant Documents (front and back) SECTION Primary ACCOMMODATION Applicant Information REQUESTS How many bedrooms do you need? Bachelor 5 (5+/6) *Please note: your selected bedroom size may not be approved for your household If you are 65 years of age or older, do you prefer senior housing sites only? Yes No *Offers of housing for Senior buildings are given to those who have reached the age of 65+ What type of accommodation do you prefer: Townhouse Apartment No Preference Do you own a vehicle? Yes No Do you require parking for this vehicle? Yes No Would you be willing to make other arrangements for your vehicle in order to accept a unit with no parking? Yes No How many spaces? *most properties only have parking spot per household Is a baby expected? Yes No If yes, due date? / / * Attach a verifying letter from your medical practitioner MM / DD / YYYY Does everyone listed on the application live with you now? If No, why not? Yes No *Please note that when offered an opportunity to view a unit only those listed on the application form can move into the offered unit 8

SECTION ACCOMMODATION REQUESTS Continued Wheelchair Accessible and/or Additional Bedroom Requests Do you, or someone in your household, require an accessible unit? Yes No a member of your household who requires the ongoing use of a wheelchair. Additional equipment is used on a full time basis: dialysis equipment, other: other: Typically, an additional bedroom will not be allowed for: Exercise equipment, unless there is a clear and permanent medical necessity and the equipment is too large to be accommodated anywhere else in the unit Snoring/Sleep Apnea Temporary medical conditions Frequent night time waking or insomnia the storage of assistive devices required due to a disability or medical equipment required for a serious medical condition on a full time basis? a separate bedroom for a spouse because of a significant disability or serious medical condition? overnight accommodation of an individual to provide support services that are required due to a medical condition/disability. The caregiver must not maintain accommodations elsewhere and must be listed as a household member on your HATCH application. IMPORTANT *Your household will not be considered eligible for a wheelchair accessible unit or an additional bedroom unless HATCH receives a Wheelchair Accessible/Additional Bedroom Request Form completed by your medical Doctor in addition to your HATCH Application Form. Call, toll free: -866--5866 (-866-HALTON) or 905-85-6000 to request a copy of this form. 9

SECTION 5 Primary INCOME Applicant AND Information ASSET INFORMATION INCOME Fill in the monthly income (before deductions) for you and each person in your household 6 years of age and older. Definition of Gross Income: An individual's total personal income before taking taxes or deductions into account SOURCE OF INCOME APPLICANT Gross Monthly Amount CO- APPLICANT Gross Monthly Amount Employment $ $ $ OTHER HOUSEHOLD MEMBER(S) Gross Monthly Amount Self-Employment $ $ $ Employment Insurance (EI) $ $ $ Workers Safety Insurance Board (WSIB) $ $ $ Ontario Works (OW) $ $ $ Ontario Disability Support Program (ODSP) Old Age Security (OAS) / Supplement $ $ $ $ $ $ GAINS A / GIS $ $ $ Canada Pension Plan (CPP/QPP) $ $ $ Other Country Pension $ $ $ Other Pension(s) $ $ $ Support Payments Received $ $ $ Support Payments Paid $ $ $ Grant/Bursary $ $ $ Other income (give details): $ $ $ Total (also include -Household Total (calculated)) 0

SECTION 5 Primary INCOME Applicant AND Information ASSET INFORMATION (Continued) Continued Notice of Assessment (most recent) line 50: $ (a copy of your most recent NOA is required more information about this request is provided on page 9) Does anyone in your household receive the following? OSAP $ $ $ Child Tax Credit $ $ $ Other $ $ $ ASSETS Fill in the value of any assets owned by you and each person in your household 6 years of age and older. TYPE OF ASSET APPLICANT CO- APPLICANT OTHER HOUSEHOLD MEMBER(S) Bank Account (give details): $ $ $ GICs/Bonds (give details): $ $ $ RRSPs (give details): $ $ $ Other assets (give details): $ $ $ Property (give details): $ $ $. Have you given away, or transferred, any property, real estate, investments or other funds/money to relatives or friends, in the past years? Has anyone in your household? If yes, give date of transfer (MM/DD/YY): If yes, what is the address of the property: Amount/Value:. Do you presently own or co-own any property suitable for year round residency, in Canada or any other country? If yes, address of property: What is the estimated value? $ Yes No Yes No $ Yes No

Submit your Notice of Assessment (NOA) Attach copies of the NOA for all adult members on your HATCH application What is a Notice of Assessment (NOA)? Each year, as a taxpayer, you complete a tax return based on your previous year s income to send to Canada Revenue Agency (CRA). The CRA issues you a Notice of Assessment (NOA) upon receipt of the tax return. The NOA is an annual statement sent by revenue authorities to taxpayers detailing the amount of your total income for the previous year. HATCH is requesting a copy of the NOA you received from your most recent tax return. Provide copies of the NOA summary page (showing line 50) for all adult members on your HATCH application. *If you have not received your NOA, contact CRA at: -800-959-88. SECTION 6 Primary PREVIOUS Applicant HOUSING Information HISTORY Household Member Previous Address Move in date m/y Move out date m/y Name of Landlord Landlord s Phone #

*Note: If you need more space for additional addresses or additional applicants, please record on a separate piece of paper and attach to this application form. SECTION 6 Primary PREVIOUS Applicant SOCIAL Information HOUSING HISTORY Continued Have you or anyone listed in your application ever lived in subsidized housing paying market rent or in receipt of a subsidy (ex. Rent -Geared-to-Income (RGI), below market rent) or been in receipt of a housing benefit in Ontario? Yes No If yes, please complete below Name of person listed on the lease Address Name of Housing Provider Type of Subsidy/ Benefit received Move- out date Arrears Owing ($) Example: John Doe 6 Pine Ave, Smithville ON L6K X9 Strong Properties Inc. RGI 0/0/008 dd/mm/yyyy Yes No Yes No Yes No Yes No Have you or any member of your household ever lived in: Oakville Burlington Milton Georgetown and/or Acton Do you currently rent from a family member? Yes No In the space below, list the name(s) of all of the Household Member(s) who currently reside in this unit:

SECTION SECTION 7 Primary SPECIAL Applicant PRIORITY Information POLICY (SPP) & LOCAL PRIORITY Applicants with verified SPP status may not be housed immediately. The Special Priority status is reserved for those who have been abused by an individual who is or was living with the abused member or A household may be eligible to be included in the Special Priority household category if a member of the household has been abused by another individual that is or was living with them. This may include an individual who is sponsoring the abused household member as an immigrant. Are you applying for Special Priority? Do you have a Sponsor? Yes No Yes No IMPORTANT: The abused member must intend to live permanently apart from the abusing individual and MUST complete a Provincial Special Priority Policy (SPP) Request for Status as a Victim of Domestic Abuse Form. To obtain a copy of the Provincial Special Priority Policy (SPP) Request for Status as a Victim of Domestic Abuse Form. Please call or visit our website and search for Provincial Priority Household Verification Form Local Priority Status: Homeless Applicants with verified homeless status will not be housed immediately. - Your wait for housing may be reduced but your wait could still be long - Buildings you select may only have vacancy in a year. Therefore, the building can offer one opportunity of housing to applicants on the wait list in that given year. Applicants on the wait list in Region may find their wait is longer than expected as buildings can only offer housing when a tenant vacates a unit. - HATCH staff has no way of knowing when you will be housed from the wait list or how long you will wait.

SECTION 7 SPECIAL PRIORITY POLICY (SPP) & LOCAL PRIORITY Local Priority Status: Homeless Continued Applicants may be deemed homeless when the applicant: - Is currently living in an emergency shelter (written verification from the shelter is required) - Awaits release from a hospital and is unable to return to his/her former accommodations due to medical reasons. (written verification from the shelter is required) - Will be evicted by his/her landlord (an Eviction Order, issued by the Landlord and Tenant Board (LTB) or the Superior Court of Justice, is required (an LTB N or L does not qualify). If the eviction is related to income misrepresentation or arrears with a social housing provider, the application will be denied as the household is not eligible to be on the social housing waitlist for RGI housing for a period of years from the date of conviction. - Has been notified by their landlord that the landlord him/herself is going to live in the applicant s unit within 60 days. (a Landlord and Tenant Board N Form, is required) Are you applying for Homeless status? Yes No Homelessness is NOT: Living in a unit with high rent without an eviction notice, Living with your parent(s) and/or family member(s) Living in a unit too small for your current household, Released from hospital but expected to return to previous address. 5

HATCH Building Selection Lists: Rent-Geared-to-Income (RGI) housing 7- - - 6-6 -6 6

Utilities Parking SENIOR APPLICANTS 7), ), ) 5) 6) ), 6), 5) -Those listed below are included Senior Community: Regular Unit Type Your completed application form and attached documents can be mailed or delivered to: Additional Details Apt # of Housing Address Access or to Community RGI Housing Unit Sizes (HATCH) Community 690 Dorval TH, Area 7 th Floor Units Oakville, ON L6K X9 ACTON (no public transportation) Lakeview Villa PHOTOCOPIED & FAXED APPLICATIONS WILL NOT BE ACCEPTED 7 Elizabeth 5 00% Incl. LTD Other free parking open balcony elevator GEORGETOWN Utilities Other Kin Court Hyde Park 00% Incl. LTD free parking Cote Terrace Seniors Apts. 7 Main Street South 0 Incl. free parking * Any offer of housing you refuse will count towards your three legislated offers of housing. 7

Utilities Parking Senior Community: Regular Unit Type Your completed application form and attached documents can be mailed or delivered Additional to: Details Apt # of Housing Address Access or to Community RGI Housing Unit Sizes (HATCH) Community 690 Dorval TH, Area 7 th Floor Units Oakville, ON L6K X9 GEORGETOWN Continued John Armstrong Terrace PHOTOCOPIED & FAXED APPLICATIONS WILL NOT BE ACCEPTED 8 Durham Street 89 00% Incl. LTD Other free parking open balcony Sargent Court Sargent Road 8 00% Incl. LTD free parking open balcony MILTON Utilities Other The Bruce Apartment 0 Ontario Street South 88 Incl. LTD free parking open balcony elevator Martin House Seniors Residence 89 Ontario Street South 80 00% Incl. free surface parking elevator BURLINGTON of QEW Utilities Other Palmer Place 097 Palmer 9 Incl. free surface parking open balcony elevator * Any offer of housing you refuse will count towards your three legislated offers of housing. 8

Utilities Parking Senior Community: Regular Unit Type Your completed application form and attached documents can be mailed or delivered to: Additional Details Apt # of Housing Address Access or to Community RGI Housing Unit Sizes (HATCH) Community 690 Dorval TH, Area 7 th Floor Units Oakville, ON L6K X9 BURLINGTON St. Luke s Close PHOTOCOPIED & FAXED APPLICATIONS WILL NOT BE ACCEPTED Elgin Street S-W 6 Incl. LTD Other free surface parking open balcony elevator Aldershot Village Residence 50 Plains Road East S-W 55 00% Incl. paid underground parking Juliette balcony elevator Wellington Terrace 0 John Street S-W 75 Incl. paid underground parking elevator Woodward Park Woodward Avenue S-W 90 00% Incl. free surface parking open balcony elevator Walkers Landing (Seniors) 5 Walkers Line S-E Heat & Hydro free parking open balcony Longmoor 00 Longmoor S-E 09 00% Heat & Hydro free parking open balcony elevator Pinedale Avenue 550 Pinedale Avenue S-E 00% Heat & Hydro free parking open balcony elevator * Any offer of housing you refuse will count towards your three legislated offers of housing. 9

Utilities Parking Senior Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details OAKVILLE Other Knox Heritage Place 9 Sixth Line N-E Incl. paid parking open balcony elevator Oakville Senior Citizens Apartment 0 Lakeshore Road West S-W 6 00% Incl. paid underground/ above-ground parking John R. Rhodes Residence 7 Kerr Street S-W 00% Incl. paid parking open balcony * Any offer of housing you refuse will count towards your three legislated offers of housing. 0

Utilities Parking Senior Community: Wheelchair Accessible Unit Type Your completed application form and attached documents can be mailed or delivered to: Additional Details Housing Apt # of Addres Communit Access or to Community RGI Housing Unit Sizes (HATCH) s y 690 Dorval TH, Area 7 th Floor Units Oakville, ON L6K X9 WCA ACTON PHOTOCOPIED & FAXED APPLICATIONS WILL NOT BE ACCEPTED Lakeview 7 5 Villa Elizabeth Incl. LTD - 00% GEORGETOWN Utilities Cote Terrace Seniors Apt. 7 Main St. South 0 50% Incl. - MILTON Utilities The Bruce Apt. 0 Ontario St. South 88 Incl. LTD - Martin House 89 Ontario St. South 80 00% Incl. 8- * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking Senior Community: Wheelchair Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON South West WCA St. Luke s Close Elgin St. S-W 6 Incl. LTD - Wellington Terrace 0 John St. S-W 75 Incl. - 7- John R. Rhodes Residence 7 Kerr St. S-W 0 Incl. 7- BURLINGTON South East Utilities Walkers Landing 5 Walkers Line S-E Heat & Hydro - * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details ACTON (no public transportation) WCA Lakeview Villa 7 Elizabeth 5 00% Incl. LTD LinksCare - MILTON Utilities The Bruce Apartment 0 Ontario Street South 88 Incl. Services for Seniors - BURLINGTON Utilities Wellington Terrace 0 John Street S-W 75 00% Heat & Hydro Services for Seniors - 7- * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON Continued WCA Westwood II 98 Falcon Blvd. S-W 00% Heat & Hydro AbleLiving Services Inc. - OAKVILLE Utilities Oakville Senior Citizens Residence Lakeshore Road West S-W 7 00% Incl. LTD Oakville Senior Citizens for Seniors Bedsit For support services at Aldershot Village Residence with Cheshire independent Living Services call 905-6-6677 * Any offer of housing you refuse will count towards your three legislated offers of housing.

What is Rent-Supplement? Region has agreements with private landlords who offer some of their units for rent-gearedto- income (RGI) HATCH applicants. The locations of these vary and can change over time. Rent supplement units are filled from the HATCH waitlist. Households that make a Rent Supplement selection below must return this form to HATCH along with their completed Annual Update Requirement form. *Building addresses where rent supplement units are located will not be provided to you as Rent Supplement locations are always subject to change. *All refusals of Rent Supplement offers of housing will count towards your legislated three offers of housing on your HATCH housing application. RENT SUPPLEMENT Unit Sizes IMPORTANT: by choosing to be placed on the expression of interest list for the area(s) listed below your household is saying they are interested in receiving rent supplement unit offers, should one come available. Senior All-Age Both Various Rent Supplement regular unit locations in Acton Please only select this housing option if you are able and willing to live in any area of Acton Various Rent Supplement regular unit locations in Georgetown Please only select this housing option if you are able and willing to live in any area of Georgetown Various Rent Supplement regular unit locations in Milton Please only select this housing option if you are able and willing to live in any area of Milton Various Rent Supplement regular unit locations in Burlington Please only select this housing option if you are able and willing to live in any area of Burlington Various Rent Supplement regular unit locations in Oakville Please only select this housing option if you are able and willing to live in any area of Oakville Please only complete this form if you are interested in Rent Supplement unit offers 5

Utilities Parking All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details ACTON (no public transportation) Other Cobblehill Homes Co-op 5 Cook Street 5 Heat paid parking open balcony no elevator 0.5 WR.5 WR Incl. paid parking Braeside 6 Holmesway Place 00% Incl. LTD free parking Holmesway Place 0- Holmesway Place 8 00%.5 WR Water & Heat free parking private driveway * Any offer of housing you refuse will count towards your three legislated offers of housing. 6

Utilities Parking All-Age Community: Regular Unit Type All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details MILTON Other 5 Rotary Bronte Square Street South 9.5 WR.5 WR Water & Heat free parking private driveway Harmony Court Ontario Street, 6 00% Incl. free surface parking open balcony elevator BURLINGTON Utilities Other Walkers Fields 00 Walkers Line 5 Excl. small backyard & free parking driveway The Manor 09 Walkers Line 8 Hydro & Water paid underground parking bdenclosed balcony bdopen balcony Driftwood 00 Driftwood 00% Water small backyard & free parking driveway Tansley Park 090 Millcroft Park.5 WR Water free surface parking small backyard * Any offer of housing you refuse will count towards your three legislated offers of housing. 7

Utilities Parking All-Age Community: Regular Unit Type All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON Continued Other 0 Van 80 Norman Guelph Place Line.5 WR Hydro & Water paid surface parking no elevator Victoria Village 6 Whittaker.5 WR Excl. LTD backyard free parking (driveway & surface) Don Quixote Co-op 5 Maple Crossing Blvd. S-W.5 WR.5 WR.5 WR Excl. small backyard & free parking driveway Maple Crossing 00 Maple Crossing Blvd. S-W 60.5 WR.5 WR Excl. small backyard free parking driveway Nelson Co-op 8A-06 Glendor Avenue S-W 90.5 WR Incl. small backyard free parking driveway Brant Court Apartment 708-70 Brant Street S-W 6 00% Incl. Very LTD free surface parking no elevator () & () bachelor units * Any offer of housing you refuse will count towards your three legislated offers of housing. 8

Utilities Parking All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON Continued STOA Coop Westwood II Burloak Walkers Landing 56 Brock Avenue 98 Falcon Blvd. 5 & 60 Burloak 55 Walkers Line & 05 Longmoor Dr S-W 9 Heat & Hydro S-W 7 Water S-E S-E 6/6 5 00%.5 WR.5 WR Heat & Hydro Excl. LTD LTD Other free underground parking open balcony or patios elevator water, fridge, stove, washer/dryer, dishwasher in unit included in rent small backyard free parking small backyard free parking driveway OAKVILLE Golden Briar Heights Elm Road Donaghey Square 50 Golden Briar Trail 78-9 Elm Road 5 Sixth Line Utilities N-E 77 Excl. N-E N-E 7 5 00%.5 WR.5 WR.5 WR Incl. Excl. LTD Other small backyard free surface parking free surface driveway small backyard free surface parking * Any offer of housing you refuse will count towards your three legislated offers of housing. 9

Utilities Parking All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details OAKVILLE Continued Interfaith Homes Birch Glen Co-op Glen Oaks Co-op The Abbeyview Brays Lane Rimmington Various units 60 Dorval 80 Dorval 50 Dorval 99 Bray s Lane N-E 57.5 WR Excl. N-W 0 Incl. N-W 8 Incl. N-W 9 Incl. N-W 5 Incl. Other free surface parking driveway small backyard paid underground parking & enclosed balcony elevator paid underground parking & enclosed balcony elevator paid underground parking & enclosed balcony elevator paid surface driveway Glen Valley Place 0 Glen Valley Road N-W 5 Excl. small backyard paid surface driveway * Any offer of housing you refuse will count towards your three legislated offers of housing. 0

Utilities Parking All-Age Community: Regular Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details OAKVILLE Continued The Oaklands 0 Merchants Gate N-W 88 Excl. Other paid underground /surface parking & open balcony elevator Margaret 87-59 Margaret S-W 8 00%.5 WR Incl. small backyard free surface parking Maurice 8-0 Maurice S-W 6 00% 00%.5 WR.5 WR Incl. surface parking no elevator surface parking detached, semidetached & row TH Prince Charles Place Prince Charles S-W.5 WR Excl. free parking driveway & surface lot Sheridan Woods 0 Sheridan Garden S-E 5 Excl. free driveway & surface parking Mariposa Co-op 50 Gable S-E.5 WR Excl. free parking driveway * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking All-Age Community: Wheelchair Accessible Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details ACTON (no public transportation) Cobblehill Homes Co-op 5 Cook Street 5 Heat WCA - - MILTON Utilities Other Rotary Square Harmony Court 5 Bronte Street, S Ontario Street, N BURLINGTON Walkers Fields The Manor 00 Walkers Line 09 Walkers Line Incl. LTD - 6 Incl. - Utilities Other 5 Excl. - 8 Hydro & Water 6- * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking All-Age Community: Wheelchair Accessible Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON Continued Driftwood 00 Driftwood Water WCA - - Tansley Park 090 Millcroft Park Excl. - Van Norman Place 80 Guelph Line 5 Heat & Water - RI - Don Quixote Co-op Maple Crossing Nelson Co-op STOA Co-op Walkers Landing 5 Maple Crossing Blvd. 5 Maple Crossing Blvd. 8A-06 Glendor Avenue 56 Brock Avenue 55 Walkers Line & 05 Longmoor Dr S-W.5 WR Excl. - - S-W 60 Excl. - S-W 90 Incl. S-W 9 S-E 6/6.5 WR Heat & Hydro Excl. - - - - RI - - & - * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking All-Age Community: Wheelchair Accessible Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details OAKVILLE Continued WCA Donaghey Square Golden Briar Heights 5 Sixth Line 50 Golden Briar Trail N-E 7 Excl. LTD - N-E 77 Excl. - Interfaith Homes Rimmington Various units S-W 57 Excl. - Birch Glen Co-op 60 Dorval S-E 0 Incl. 6- RI 6- RI - RI Glen Oaks Co-op 80 Dorval S-E 8 Incl. 6-6- RI - The Abbeyview Glen Valley Place 50 Dorval 0 Glen Valley Road S-W 9 Incl. - S-W 5 Excl. - * Any offer of housing you refuse will count towards your three legislated offers of housing.

Utilities Parking All-Age Community: Wheelchair Accessible Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details OAKVILLE Continued WCA The Oaklands Prince Charles Place Sheridan Woods Jean & Howard Caine Apartment 0 Merchants Gate Prince Charles 0 Sheridan Garden 59 Robinson Street N-W 88 Incl. - - - S-W Water - S-W 5 Excl. - S-E 58 All Incl. 50- RI 8- RI * Any offer of housing you refuse will count towards your three legislated offers of housing. 5

Utilities Parking All-Age Community: Support Service Unit Type Housing Community Address Apt or TH Area # of RGI Units Unit Sizes Additional Details BURLINGTON WCA Palmer Place 097 Palmer Excl. LTD AbleLiving Services Inc. - RI OAKVILLE Utilities Jean & Howard Caine Apartment 59 Robinson Street S-E 58 All units are WCA RI Incl. Ontario March of Dimes Canada (MoDC) *Applicants must have a physical disability For Support Services at Wellington Terrace at 0 John Street, Burlington Contact Community Living Burlington Directly At: 905-6-5 * Any offer of housing you refuse will count towards your three legislated offers of housing. 6

SECTION SECTION 8 Primary DECLARATION Applicant Information AND CONSENT You are required to sign this form as a part of your HATCH application. By signing this form you are providing Region with the following: () your acknowledgement that Region is collecting your information for the purposes of determining your eligibility to be active on the Access to Community Housing (HATCH) wait list for rent-geared-to-income (RGI) housing; () your consent for Region to share your information with other government agencies to determine/verify your eligibility for their programs; and () your solemn declaration to Region that all the information you have provided in your HATCH application is true, that you are in Canada legally, and that you understand your responsibilities regarding your HATCH and RGI eligibility. Please read this form carefully and sign in the space(s) provided below. All people 6 years of age and older who are going to live with you must sign this form.. Notice of Collection of Information I acknowledge that Region and the housing providers to whom I will be applying are authorized to collect personal information on this form in accordance with section of the Housing Services Act, 0 and that the information will be used to determine eligibility for rent-geared-to income (RGI) and/or Special Needs Housing. Any questions about the collection of my personal information should be directed to the Manager, Housing Services, 690 Dorval, 7th Floor, Oakville ON L6K X9, 905 85-6000, or toll free -866--5866, TTY 905 87-98. I acknowledge that HATCH will use the information I give them for the following specific purposes: To find out if I qualify for an RGI subsidy and the housing that I have applied for; To find out if I continue to qualify for RGI assistance and/or special needs housing; To find out how much assistance I am eligible to receive; For statistical reporting and policy research; Referrals to appropriate internal agencies.. Consent to Share Your Information I allow Region and the housing providers to whom I will be applying to share my personal information, without further notice to me, with the Ministry of Municipal Affairs and Housing, the Housing Services Corporation, other municipal service managers or district social services administration boards or lead agencies as defined under the Housing Services Act, 0 and each person or organization providing services by contract to any of them, if it is needed to make decisions or verify my eligibility for assistance under the Housing Services Act, 0, the Ontario Works Act, 997, the Ontario Disability Support Program Act, 997 or the Day Nurseries Act, 990. I consent to Region giving my personal information to government agencies that enforce the Income Tax Act and/or the Immigration and Refugee Protection Act. I understand that all information I provide to Region will be given to all housing providers I apply to, as well as appropriate internal agencies. 7

. Declaration I solemnly declare the following: Everything I have written in this application is true, correct and complete. I understand that if information on this application is missing, incorrect or false, Region or the Housing Providers I have applied to may request additional information or may cancel my RGI housing application. I understand that only the people I have listed on this application form may live with me in (RGI) housing. I am in Canada legally. I understand that I must make arrangements to pay all money I owe to any social housing provider prior to my application being placed on the HATCH wait list, and to provide verification to HATCH. I understand that I must report any changes to the information on this application directly to HATCH immediately which includes changes to my phone number, address, email address, income, and status in Canada or family composition. I understand that if I fail to respond to correspondence from HATCH or fail to provide required documentation to HATCH, my RGI housing application may be cancelled. I understand that it is an offence under the Housing Services Act, 0 for an applicant or any individual to knowingly obtain or assist a household member to obtain RGI assistance for which they are not entitled. Such an offence carries up to a $5,000 fine or up to six months imprisonment, as well as a prohibition from re-applying for assistance for a minimum period of two year. Household Signatures (pg. 8-9) Please sign where appropriate below (include signature of all household members 6 years of age and older). Applicant Signature Applicant Print Name Co-Applicant Signature Co-Applicant Print Name Date: Date: Household Member Household Member Household Member Signature Print Name Household Member Signature Print Name Date: Date: 8

. Household Signatures Continued Signatures of other household members 6 years of age or older: Household Member Signature Household Member Print Name Household Member Signature Household Member Print Name 5 6 Date: Date: Household Member Signature Household Member Print Name Household Member Signature Household Member Print Name 7 Date: 8 Date: 5.Two-way Consent Do you want HATCH and your support or agency worker to have permission to speak directly with each other about this HATCH application form and/or any other form related to HATCH? If yes, please complete this section I give from Applicant Full Name permission to communicate Name of the agency or company where the Professional named above works Professionals Full Name with HATCH regarding any and all issues pertaining to my RGI housing application and my application for priority with HATCH. Priority status you have applied for with HATCH Communication may occur for a period of 6 Months Year other Applicant Signature Print Name Date: 9