DO YOU PREFER TO PRINT YOUR APPLICATION AND MAIL IT? PLEASE DOWNLOAD HERE. Step 1 of 4 25% Name of Applicant*Date of Birth* Age*Name of Co-ApplicantDate of Birth AgeMarital Status*SingleMarriedSeparatedWidowedDivorcedInter-dependent RelationshipAddress* Street Address City Province ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone #*Emergency Contact Name*Phone #*Relationship to Emergency Contact Name*Family Doctor*Phone #*Are you a*Canadian CitizenLanded ImmigrantIf a translator is required, please provide their contact informationNamePhone # FINANCIAL - no application will be processed without the following *** PLEASE ATTACH COPIES OF CURRENT INCOME TAX RETURN AND NOTICE OF ASSESSMENT *** Please list a dollar value of ALL your assets. BE SPECIFIC. Upload Copies here Drop files here or Bank Accounts (chequing & saving)*RRSP & RIP*Real Estate*Rental Properties*GIC*Stocks and Bonds*Stocks and Bonds*Other (specify what and how much)ACCOMMODATIONDo you currently*RentOwnPresent Landlord's Name*Phone*Previous Landlord's NamePhone *If you have no landlord references please provide the contact information for two character references. Note: Cannot be a family member. *YOU MUST PROVIDE REFERENCES TO HAVE YOUR APPLICATION PROCESSED. Rent/Mortgage*Do you currently pay for?* Electricity Heat City Services Why do you wish to move?*FinancialOvercrowdedCloser to familyRelationship BreakdownLimited accessibility (stairs, distance from amenities)**You may use this additional space to provide further details on why you wish to move. The more detail we have the better we are able to assess your need for housing.*Have you received a written notice to vacate (attach copy)?*YesNoUpload file here Please number in order of preference which building you would like to be placed*Barrett Kiwanis PlaceCanyon View Kiwanis PlaceCentennial Kiwanis Courts Please number in order of preference which building you would like to be placed*Fleming Kiwanis ManorCrimson VillasWaskasoo Kiwanis Towers *Please note that all buildings are moving towards a Smoke Free policy* Please note any special requests (Main floor, upper floor, wheelchair accessible suite):**Please note that the Bridges Community Living will do our best to accommodate you in your building of choice, however, please be advised that being too selective may increase your wait time. Do you have a motorized mobility aid* Scooter Motorized wheelchair No OtherWeight of aidLength of aidWidth of aidWeight of aid*Length of aid*Width of aid*Liability insurance* Yes No ParkingAutomotive parking spaces with the Bridges Community Living are very limited and are issued on a first come first serve basis. Parking spaces will only be given to tenants with their own vehicles. Do you want to add your name to the parking waiting list?* Yes No Have you rented accommodations from Bridges Community Living or Twilight Homes in the past?* Yes No DECLARATIONDominion of Canada} In the matter of application for accommodation with the Piper Creek Foundation} I,*of the City* in the province of Alberta, do solemnly declare as follows: 1. That I am the applicant named in this application; 2. That the statements made by me in this application are to the best of my knowledge, information and belief, full and true in all respects and authorize the Piper Creek Foundation or its agents permission to investigate any or all of the statements made by me in this application; And I make this solemn declaration conscientiously believing it to be true and knowing that is of the same force and effect as if made under oath and by virtue of the "Canada Evidence Act". Declared before me at the City of*In the province of Alberta, this* Signature of Applicant*A Commissioner for Oaths in and for the Province of AlbertaPrinted name of Commissioner for OathsAppointment expiry date CAPTCHA