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.

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.

Personal Information


Other Household Members (Max. Double Occupancy)


Present Address


Employment Information


Vehicle Information


Additional Information


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.


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