Family Centre Application Form

Need help filling out this form? Call our office anytime: 604-795-2322

PLEASE NOTE: YOU MUST MEET THE FOLLOWING APPLICATION REQUIREMENTS TO BE CONSIDERED:
• Must have legal guardianship of one or more children
• Must have a legal dependant under the age of 19
• Must be in the ‘low income’ tax bracket
• Must be willing to live in a smoke/vape free environment
• Must be willing to live in a pet-free building

CAPACITY NOTE: Our Family Centre is currently at capacity. Please still apply, and we will call if you if there is an opening. Applications are kept on file for 3 months from the date that you submit your form. If you haven’t heard from us within 3 months, please re-apply below.

Applicant full name *

First Name

Last Name

Email *

Phone *

Country

(###)

###

####

Applicant #2: Full name, age, date of birth, gender & relationship to applicant

Applicant #3: Full name, age, date of birth, gender & relationship to applicant

Applicant #4: Full name, age, date of birth, gender & relationship to applicant

Do all of these people live with you full time? *

Yes

If you answered "No" to the above, please explain:

Will the number of people living with you change within the next 12 months? *

Yes

If you answered "Yes' please explain:

Please describe your current living situation in as much detail as possible below. *

SECTION 2: ADDITIONAL REFERENCES

NOTE: We do no accept family members as references

Reference #1: Name, relationship to applicant, contact information *

Reference #2: Name, relationship to applicant, contact information *

Reference #3: Name, relationship to applicant, contact information *

SECTION 3: INCOME INFORMATION

Please list income details for everyone age 19 or older.

Income Earner #1: Full name, income source(s), gross monthly income. *

Income Earner #2: Full name, income source(s), gross monthly income.

Income Earner #3: Full name, income source(s), gross monthly income.

Household cash / savings *

Household real estate *

Household stocks / investments *

Other

Do you or your partner own land in Canada? *

Yes

DOCUMENTS TO PREPARE

NOTE: All applicants must provide proof of income by providing some of the following documents (if applicable). Please prepare these documents in case you receive an application approval from us. + Your most recent Notice of Assessment + Your most recent T4 + Your Child Tax Credit + Your most recent tax return + Any and all social services subsidies

SECTION 4: WHAT ARE YOU APPLYING FOR?

NOTE: The RAN Family Centre offers several different residential units. Please indicate which of the following units you are applying for. NOTE: Rent cannot exceed 30% of your gross income. *Utilities/Internet not included. (Internet/Cable package available for a discounted price). **Tentative Rent Cost

Apartment options *

1 Bedroom ($692 / month)

2 Bedroom ($831 / month)

3 Bedroom ($965 / month)

SECTION 5: OUR PURPOSE

The purpose of the RAN Family Centre is to help protect and strengthen the family unit.

Please indicate your willingness to participate and/or your understanding of the following items: *

I am willing to live in a smoke-free property.

I am willing to live in pet-free housing.

I am willing to participate in Family Enhancing Programs.

My information is correct *

Yes

Thank you! We’ll be in touch if your application is approved.

(604) 795-2322
info@ranmission.ca

Ruth and Naomi’s Mission acknowledges with humble gratitude that our sites are located on the traditional unceded lands of the Stó:lō Coast Salish peoples

Administration Hub:
46129 Princess Ave.
Chilliwack, BC, V2P 0J1

Mailing Address:
P.O. Box 327 Station Main
Chilliwack, BC V2P 6J4