Emergency Housing Application Please fill out the form below to apply for and emergency suite. If you prefer, you can download the application and submit it to email@example.com. Emergency Suite Application Step 1 of 2 50% Name(Required) First Last Contact phone number(Required)D.O.B.(Required) Month Day Year Relationship status(Required)MarriedSingleCommon-lawDo you have pets?(Required) Yes No How many and what type?(Required) Source of income(Required) Please enter N/A if you at present you do not have a source of incomeMonthly Income(Required)Please enter a numerical value.Name of employer Phone number of employerEIA Worker EIA Number Current address(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Current housing provider's name(Required) Current housing provider's phone number(Required)Lenght of current residency(Required) Reason for moving(Required) Previous address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Previous housing provider's name Previous housing provider's numberLength of tenancy Reason for movingPlease provide 2 references who can vouch for your characterReference 1: Name(Required) Relationship(Required) Phone number(Required)Reference 2: Name(Required) Relationship(Required) Phone(Required)Select all that apply. Priority will be given to the following:(Required)HomelessCouch surfingCurrently living in an unstable family situationPoor quality housingPresently residing in hospital or shelterRequire different housing type due to medical issuesAcknowledgment(Required) I acknowledge the conditions of this application.I understand that this application does not guarantee me an E-Suite. However, I will be considered for tenancy and placed on a waiting list. I understand the CMHA is not able to provide me with a specific time that an E-Suite may open but will contact me if my application is approved/I am next on the waiting list.