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    Appendix 1 Rent Bank Intake Loan Application Form

    Uploaded by

    alexxmain555
    This document is a rent bank loan application for Sources Advocacy, Housing & Prevention Services. It requests contact and financial information to determine eligibility for a short-term loan to help with rent or utility payments. The process takes 2-3 weeks from initial inquiry to receiving funds. The application collects information about the applicant's current housing and financial situation, including income, expenses, reasons for crisis, and other resources explored. It also asks questions to confirm eligibility, like length of residence, ID, bank statements, addiction history and references. The contact record section is for office use to track communication and status.

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    Appendix 1 Rent Bank Intake Loan Application Form

    Uploaded by

    alexxmain555
    7 views2 pages
    This document is a rent bank loan application for Sources Advocacy, Housing & Prevention Services. It requests contact and financial information to determine eligibility for a short-term loan to help with rent or utility payments. The process takes 2-3 weeks from initial inquiry to receiving funds. The application collects information about the applicant's current housing and financial situation, including income, expenses, reasons for crisis, and other resources explored. It also asks questions to confirm eligibility, like length of residence, ID, bank statements, addiction history and references. The contact record section is for office use to track communication and status.

    Original Description:

    Rent Bank Application

    Original Title

    Appendix-1-Rent-Bank-Intake-Loan-Application-Form

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    This document is a rent bank loan application for Sources Advocacy, Housing & Prevention Services. It requests contact and financial information to determine eligibility for a short-term loan to help with rent or utility payments. The process takes 2-3 weeks from initial inquiry to receiving funds. The application collects information about the applicant's current housing and financial situation, including income, expenses, reasons for crisis, and other resources explored. It also asks questions to confirm eligibility, like length of residence, ID, bank statements, addiction history and references. The contact record section is for office use to track communication and status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views2 pages

    Appendix 1 Rent Bank Intake Loan Application Form

    Uploaded by

    alexxmain555
    This document is a rent bank loan application for Sources Advocacy, Housing & Prevention Services. It requests contact and financial information to determine eligibility for a short-term loan to help with rent or utility payments. The process takes 2-3 weeks from initial inquiry to receiving funds. The application collects information about the applicant's current housing and financial situation, including income, expenses, reasons for crisis, and other resources explored. It also asks questions to confirm eligibility, like length of residence, ID, bank statements, addiction history and references. The contact record section is for office use to track communication and status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Sources Advocacy, Housing & Prevention Services

    Rent Bank Loan Application

    NOTE: Completion of this form does NOT guarantee loan approval. Please also note that the process takes
    roughly 2-3 weeks from when you first make an inquiry to when you receive funds.

    CONTACT INFORMATION
    Name Telephone  Do NOT leave message Alternative Telephone (optional)

    Email (optional) Preferred Method of Contact: Gender


     Phone  Email  Other:  Male  Female  Other

    Current Address City Postal Code

    Canadian Citizen  Yes Age  <19  19-59  >60 Family Status  Single or  Couple
    If no, what status
    Date of Birth (MM/DD/YY): # of Dependent Children:

    Referred by Intake Date: Intake Worker Intake Database #

    CLIENT SERVICE REQUEST


    Current Housing Emergency – check all that What is your current monthly rent?
     Received Eviction Notice
     Already Evicted/Currently Homeless If BEHIND on rent, how much do you owe (i.e. rental arrears)?
     Cannot Make Next Month’s Rent
     Behind in rent payments If you need NEXT month’s rent how much do you need?
     Received Verbal Eviction Warning
     Received Utilities Disconnection Notice If behind with UTILITY payments, how much do you owe?
     Utilities are Already Disconnected
    BC Hydro: ______________Fortis: _________________
     Behind in Utilities
     Need Damage Deposit What is the total amount of assistance you require?
     Need 1st Month’s Rent
     COVID-19 Related
    What is the cause of your current crisis?

    What other resources/alternatives have you sought out?

    Newton Resource Centre, April 2020


    What are possible solutions to your housing crisis?

    Additional Information/Comments/Considerations?

    ELIGIBILITY QUESTIONNAIRE
    How long have you lived at your current How long have you lived at your previous Are you planning to move soon?
    address? address?  Yes  No
    What are your total monthly expenses FAMILY Income Source(s) Other source(s) of income (e.g. Children
    (including rent)?  Employment: $_________ Tax Benefit, child support, etc.)

     Income Assistance (IA): $_________


     Persons With Disability (PWD): $_______
     Pension $_________
    Total: $__________/year/month Total: $__________/year/month Total: $__________/year/month
    Do you have a bank account? Do you have any credit cards, pay day Have you recently declared
     Yes  No loans or other loans? bankruptcy?
     Yes  No  Yes  No
    Can you provide 3 months of bank If yes, what is the total amount of all If yes, has your bankruptcy been
    statements? credit card/loan debt? discharged?
     Yes  No  Yes  No  N/A
    Total: $__________
    Do you have 2 pieces of government Do you have any personal references? Have you been free of substance
    issued ID (One Photo)?  Yes  No addictions for 1 year?
     Yes  No  Yes  No
    Have you attached your 3 months bank Applicant’s Signature: Date of Application:
    statements to this application?
     Yes  No  N/A
    CONTACT RECORD (OFFICE USE ONLY)
    1st Call Back  LM to CB N/A Appointment Time

    2nd Call Back  LM to CB  N/A

     Provided information  Unable to contact Date Closed Worker Initial Program Database #
     Assistance provided  No help currently needed
     Provided referral  Moved to HF

    Newton Resource Centre, April 2020

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