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Tahltan Housing Application

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– Step 1 of 2

Applicant's Information

Full Name *

First

Middle

Last

Band No. *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Birthdate *

Pets *

Yes
No

Smoker? *

Yes
No

Marital Status *

Number of occupants living with you *

Please provide their names, relationship to you, birthday, and age *

of Preference Field

Approximate year home was built *

Type of home *

Own
Rent
Relatives

Presently living: *

On Reserve
Off Reserve

Field #10 (copy)

Previous Landlord Information

Please note that references will be contacted

Name *

Phone *

Source of Income

*

Social Assistance
Old Age Security
Employed
Other

Amount of Income *

Employer Information (if applicable)

Please note that references will be contacted

Name *

Phone *

Address *

Type of Housing Required

*

New
Renovation
Stikine Housing
Tahltan Band Housing

Location/Community Preference *

Emergency Contacts

Name *

Phone *

Name *

Phone *

References

Please note that references will be contacted

Name *

Phone *

Address *

Email *

Name *

Phone *

Address *

Email *

*

I certify that my answers are true and complete to the best of my knowledge

*Proof of employment/financials and letter of interest required to complete application*

Date *

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PO Box 45, Telegraph Creek British Columbia V0J 2W0 250-235-3151 tel 250-235-3244 fax info@tahltan.ca