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.

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Kamloops Merritt Penticton
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Kamloops Merritt Penticton
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Kamloops Merritt Penticton
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Kamloops Merritt Penticton
Contact

Cookies Place Application Form

Please fill out the form in its entirety to the best of your ability. If you have any questions please call Leanne Maloney at ASK Wellness on 250-571-9105.

Cookies Place Rental Application

Personal Information

First Name

Middle Name

Last Name

Date of Birth

BC Housing Registry File Number (If Available)

Home Phone

Cell Phone

Email Address

Other Household Members (Max. Double Occupancy)

First Name

Middle Name

Last Name

Date of Birth

Present Address

Street Address

Unit or Apartment Number

City

Province

Postal Code

Country

Landlord Name

Landlord Phone Number

Length of Tenancy

Approval to Contact Landlord (please select)

Yes

No

Reason for Leaving

Employment Information

Employment Status

Employed

Retired

Disability

Occupation

Length of Employment

Annual Income

Are you applying for a subsidy?

Yes

No

Vehicle Information

Do you require a parking stall? (Cost is $25/mo)

Yes

No

Vehicle Make

Vehicle Model

Year

Colour

Additional Information

Do you have pets?

Yes

No

Pet Type

Gender

Pet Name

Pet Neutered or Spayed?

Yes

No

Do You smoke? (This is a non-smoking building)

Yes

No

Do You require an accessible unit?

Yes

No

Consent

I/We, the undersigned consents to the landlord obtaining credit and personal information in regards to the Application for Subsidy from the applicant and other such sources. The applicant authorizes the reporting agencies (including personnel from Government Agencies or Ministries) to discuss relevant information about the Applicant with the Landlord.

Print Name

Print Your name (printing your name here is equivalent to your Signature)

Date

I have answered all the questions truthfully to the best of my ability

I understand that if I am applying for a subsidy, I must provide financial information as requested, failure to do so will result in the application for tenancy being denied.

I understand that occupancy is not until Janury 1, 2022 11am and no one will be permitted on site before then.

I understand that laundry, utilities, telephone, cable and internet are not included in the rent, and that I will be responsible for setting up and maintaining personal accounts in my name for these services

ASK Wellness is COA Accredited

COA accreditation signifies that an organization or program is effectively managing its resources and providing the best possible services to all of its stakeholders. It also signifies that an organization or program meets standards of quality set forth by the COA accrediting body.

For more information about COA accreditation visit coanet.org.

Inclusive

The ASK Wellness Society is working towards providing and improving the available resources for 2sLGBTQ+ individuals in our communities by implementing 2SLGBTQ+ outlets at our sites and through advocating for 2SLGBTQ+ rights and respect. We welcome all and any members of the 2SLGBTQ+ community to access our resources.

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