Rental Housing Application

Application Date & Time *

Date

Time

Name of Applicant *

First

Middle

Last

Birth Date *

MBQ Status Number *

10-digit #

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone Number *

Email Address *

* By providing a valid email address, you are consenting to receive e-communication from the MBQ Housing Department *

Name of Co-Applicant

First

Middle

Last

MBQ Member?

Yes
No

MBQ Status Number

10-digit #

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth

Primary Phone Number

Email Address

* By providing a valid email address, you are consenting to receive e-communication from the MBQ Housing Department *

Applicant Information

Have you rented from MBQ in the past? *

Yes
No

If yes, when?

Do you require an accessible unit? *

Yes
No

Do you have pets? *

Yes
No

Please specify number of dogs, cats etc.

Risk of Homelessness

So you identify as homeless? *

Yes
No

Do you identify as a person or household who are at risk of homelessness? *

Yes
No

If YES, please identify below:

Pays 50% or more of their monthly income for their current dwelling
Has insufficient resources immediately available to attain housing stability
Has moved frequently because of economic reasons
Lives in the home of another because of economic hardship
Has been notified that your right to occupy your current housing or living situation will be terminated
Lives in a hotel or motel
Lives in severely overcrowded housing
Otherwise live in housing that has characteristics associated with instability and an increased risk of homelessness

This will include applicants with documented accessibility issues. Please describe below:

Employment

Applicant Employer *

Applicant Position *

Applicant Length of Employment *

Co-Applicant Employer

Co-Applicant Position

Co-Applicant Length of Employment

Total Family Income

Annual / Monthly / Weekly *

Applicant Source of Income *

Please check all that apply.

Applicant Total Income *

Verification of Income

Click or drag a file to this area to upload.

Please attach a complete Income Statement

Annual / Monthly / Weekly *

Co-Applicant Source of Income

Please check all that apply.

Co-Applicant Total Income

Verification of Income

Click or drag a file to this area to upload.

Please attach a complete Income Statement

Landlord Reference

First time renter(s) must provide a character reference letter.

Contact Name *

First

Last

Contact Phone Number *

Contact #2 Name *

First

Last

Contact #2 Phone Number *

Character Reference Letter for First Time Renters

Click or drag a file to this area to upload.

Please upload your Character Reference Letter

List of Occupants

Will there be additional occupants in the unit? *

Yes
No

Name *

First

Last

Date of Birth *

Status Number *

Relationship to Applicant *

Name

First

Last

Date of Birth

Status Number

Relationship to Applicant

Name

First

Last

Date of Birth

Status Number

Relationship to Applicant

Name

First

Last

Date of Birth

Status Number

Relationship to Applicant

Name

First

Last

Date of Birth

Status Number

Relationship to Applicant

Declaration

I/We give my/our consent and authorization to the Mohawks of the Bay of Quinte Housing Department on behalf of the Tyendinaga Mohawk Council to: *

Make any inquiries that it deems necessary to verify the information given in this form and I/We authorize any person, corporation or any social agency having the knowledge of any such required information to release the information to the Mohawks of the Bay of Quinte Housing Department. I/We agree to provide any supporting material required to process this rental application.
I/We certify that the personal information and documents submitted, or to be submitted, in this application, are true, complete, and correct, including my declarations made within the enclosed application. I/We certify that my personal and other circumstances in my application are true, accurate and authored solely and entirely by me and that all information requested in this application has been disclosed.
I/We understand that any false or misleading information may cause negative consequences, up to and including that my application will not be approved for cause of an intentional misstatement of fact.
I/We understand that it is my/our responsibility to keep the MBQ Housing Department where I have applied or registered (as a Housing resident once approved) informed of any changes to the information in my application, and I/We agree to update my/our application and housing information immediately after any such change occurs.
I/We consent to receiving e-communication from the MBQ Housing Department and confirm that I/We have provided a valid e-mail address.

Applicant Signature *

Date *

Co-Applicant Signature

Date

Applicant Information

Risk of Homelessness

Employment

Total Family Income

Landlord Reference

List of Occupants

Declaration

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