The ASK Wellness Society would like to acknowledge that our programs and facilities operate on Secwepemcúl'ecw, Nłeʔkepmx Tmíxʷ, and Syilx tmixʷ traditional and unceded territories.
History, Mission, Vision
Team & Board
ASK Wellness Society
Housing Exit Report
Housing Exit Report
Program Participant First Name
Program Participant Last Name
Details of Exit
Reason for Exit
Eviction due to non-payment of program fee/rent
Eviction due to behaviour (failure to follow program agreement). Please complete index 1. if you select this option
Eviction due to suite abandonment
Successful graduation from program
Transfer to Other ASK Housing. Please complete Index 2 if you select this option.
Program participant found more suitable housing. If you select this option please complete Index 3.
Program participant chose to leave the program
Program participant deceased
Exited to facility or program to support critical health needs
Other (please complete below)
If you selected 'other' please provide more information
Index 1: If you selected Eviction due to behaviour (failure to follow program agreement) please select the Largest Factor(s) behind behaviours
Mental Health and Substance Use
If other input here:
If you selected Eviction due to behaviour, was there an RCMP removal?
If there was no RCMP removal, did you contact the shelter?
Yes, shelter bed confirmed
Yes, no shelter bed confirmed
If shelter unavailable, did you contact anyone else?
Yes, contacted their listed emergency contact
Yes, contacted ASK Outreach (Kamloops)
No, no additional contact
Identify any current community supports connected to the individual who was contacted
Index 2: If the Program Participant is transferring to other ASK housing, please enter where they are transferring to
Index 3: If the Program Participant found more suitable housing, please input the form of housing.
Index 4: Please input 'other' description
Summary of Exit Details
Your email (the person who is submitting this form)
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