Paqtnkek Housing Application

Where the applicant still needs to receive a housing unit during the calendar year and is still interested in doing so, the band member must complete and submit a new application annually after April 1st of each year. Applicants MUST provide any supporting documents where applicable.

Applicant Information

Your Email Address(Required)

We need this to send you a confirmation email after you submit your application.

Are You Applying Alone?(Required)

Yes

Applicant Name(Required)

First Middle Last

Applicant Date of Birth(Required)

YYYY slash MM slash DD

Applicant Social Insurance Number (SIN)(Required)

Applicant Marital Status(Required)

Applicant Current Residence(Required)

Street Address Unit # City Province Postal Code

Applicant Primary Phone(Required)

Applicant Alternate Phone

Is Applicant A Paqtnkek Band Member?(Required)

Yes

Is Applicant Born In Paqtnkek?(Required)

Yes

Is Applicant Raised In Paqtnkek?(Required)

Yes

Applicant Band Number(Required)

Applicant Proof of Band Membership(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Co-Applicant Information

Relationship With The Primary Applicant?(Required)

Co-Applicant Name(Required)

First Middle Last

Co-Applicant Date of Birth(Required)

YYYY slash MM slash DD

Co-Applicant Social Insurance Number (SIN)(Required)

Applicant Marital Status(Required)

Co-Applicant Current Residence(Required)

Street Address Unit # City Province Postal Code

Co-Applicant Primary Phone(Required)

Co-Applicant Alternate Phone

Is Co-Applicant A Paqtnkek Band Member?(Required)

Yes

Is Co-Applicant Born In Paqtnkek?(Required)

Yes

Is Co-Applicant Raised In Paqtnkek?(Required)

Yes

Co-Applicant Band Number(Required)

Co-Applicant Proof of Band Membership(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Type of Assistance Required

Type of Housing Assistance Required(Required)

Dependants

Do You (and/or the co-applicant) Have Dependents?(Required)

Yes

Are Your Dependents Subject To A Custody Arrangement Between Yourself And A Former Partner?(Required)

Yes

Please Provide Additional Custody Details:(Required)

Upload Supporting Documentation To Custody Arrangement(Required)

Drop files here or

Accepted file types: jpg, png, pdf, doc, Max. file size: 64 MB.

Dependants(Required)

Name

Band Number

Date of Birth (YYYY/MM/DD)

Special Considerations

Do you, the co-applicant, and/or any dependents require special considerations for housing (i.e. medical conditions, barriers with mobility and accessibility, visual/hearing conditions, neurological conditions, etc.)

Yes

Do you require wheelchair accessibility?

Yes

Do you have a visual impairment?

Yes

Do you have limited or no hearing?

Yes

Do you have a full or part-time attendant

Yes

Special Considerations Uploads

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 64 MB.

Current Dwelling

Please Explain Your Current Dwelling Situation:(Required)

Are You Paying Rent?(Required)

Yes

What Is Your Payment?(Required)

What Is Your Payment Schedule?(Required)

Landlord or Organization?(Required)

How Long Have You Been Renting?(Required)

Are You Willing To Sign A Tenant’s Agreement?(Required)

Yes

Will You Relinquish The Unit You Are Now Occupying?(Required)

Yes

Applicant’s School Status

Does The Applicant Receive Social Assistance, Disability, or Employment Insurance?(Required)

Yes

Is The Applicant A Student?(Required)

Yes

Applicant Status?(Required)

Full-Time

Part-Time

Where Does The Applicant Attend School?(Required)

Does The Applicant Receive Post Secondary Financial Assistance?(Required)

Yes

Co-Applicant’s School Status

Does The Co-applicant Receive Social Assistance, Disability, Or Employment Insurance?(Required)

Yes

Is The Co-Applicant A Student?(Required)

Yes

Co-Applicant Status?(Required)

Full-Time

Part-Time

Where Does The Co-Applicant Attend School?(Required)

Does The Co-Applicant Receive Post Secondary Financial Assistance?(Required)

Yes

Applicant Employment Status

Is The Applicant Currently Employed?(Required)

Applicant Employment Status?(Required)

Applicant Employers Name?(Required)

Applicant Employers Address(Required)

Street Address Address Line 2 City Province Postal Code

Applicant Payment Frequency(Required)

Co-applicant Employment Status

Is The Co-Applicant Currently Employed?(Required)

Applicant Employment Status?(Required)

Co-Applicant Employers Name?(Required)

Co-Applicant Employers Address(Required)

Street Address Address Line 2 City Province Postal Code

Co-Applicant Payment Frequency(Required)

Declarations

Applicant(s) Declarations(Required)

I/We declare that all information in this application is accurate to the best of my/our knowledge.

I/We give permission to Paqtnkek Housing Department to verify the information in my application for housing

I/We acknowledge that falsified or misleading information will jeopardize the application's success.

Applicant Signature(Required)

Please Type Applicant Name(Required)

Co-applicant Signature(Required)

Please Type Co-Applicant Name(Required)

Name

This field is for validation purposes and should be left unchanged.

Paqtnkek Housing Application

Applicant Information

Co-Applicant Information

Type of Assistance Required

Dependants

Special Considerations

Current Dwelling

Applicant’s School Status

Co-Applicant’s School Status

Applicant Employment Status

Co-applicant Employment Status

Declarations

Mi’kmaq

The Algonquian Indigenous nation that occupies the territory of Mi’kma’ki (Atlantic Canada and the Gaspé peninsula). This spelling indicates a reference to the collective or the plural form. It roughly translates to “family” or “relations.”

Reach Out With Any Questions

7 Dillon Street | Afton Station