Application Form For Dwellings - Federation Regionale Des Osbl D'Habitation (Page 4 of 4) in pdf

Yes 

No 

Have you ever been a member of a board of director?

Name of organization :

Duration of involvement

From :

To :

Person to contact :

Phone number :

Consent for references and experience in volunteer work or member of a board of directors

I, the undersigned,

give authorization to the members

responsible of the selection comity to contact the organizations above for references:

Signature :

Date :

OWNERS REFERENCES

Name and surname of actual owner :

Address :

Phone number :

Duration of time (lease) :

From :

To :

Name and surname of previous owner (within the last 3 years) :

Address :

Phone number :

Duration of time (lease) :

From :

To :

Consent for owners references

I, the undersigned

give authorization to the members

responsible of the selection comity to contact the owners above for references.

Signature :

Date :

ANIMALS

Do you have animals

If yes, how many :

YES



What kind (dogs, cats, birds, ect.)

What is the weight of your animal :

Most of our organizations do not accept animals (except cats and fish).

YES



Would you able to depart from your animals?

I certify, by the present, that the information given here is truthful and conforms to reality. I authorize the ‘’Fédération régionale des OSBL d’habitation de la

Montégérie’’ to release this information to other Non-Profit Organizations (NPO) in low cost rental housing dwellings for housing unit purposes only. I

understand that this application does constitute neither an acceptance nor an obligation from a Non-Profit Organization to provide me with a

dwelling. I consent that the information provides excluding my name and other personal data can be used by the ‘’Comité lodgement Rive-Sud’’ for their

statistics in view exclusively to develop community housing projects.

The applicant who does not present himself for his interview with the selection comity and who does not inform of his absence to the person responsible for

interviewing will have his name revoked from the lists for a period of 24 months. In case of impossibility to attend the scheduled interview, please contact :

(450) 201-0786 #6.

All acts of physical of verbal abuse or intimidation towards the selection comity volunteers and/or the staff of ‘’FROHM’’ will lead to a direct withdrawal of your

application.

List 1 : All applications of list 1 must renew their application before September 1

of each year to maintain their status.

List 2 : For applicants of list 2, their application will be valid for a period of 24 months from the date of reception at the office. Once expired, the applicant

must reapply for a new application.

If an applicant is not admissible for list 1, low cost rental housing subsidized dwellings, due to selection comity rules and by-laws and rules respecting the

allocation of dwellings in low cost rental housing of ‘’Société d’habitation du Québec’’ (SHQ), would the applicant be interested in applying for list 2 for

social housing non-subsidized dwellings.

Yes

In both cases, please inform the office of all changes of address and phone number.

Signature :

Date :

Please send to : 311 McLeod street, Châteauguay (Québec) J6J 2H8 or by fax at (450) 699-7014

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