VC Application for Accommodation


Who is Eligible
Permanent residents of Canada, residing in British Columbia who are not under

Generally, people are eligible for housing if their household income falls below an
Amount, set annually, and their rent exceeds 30 per cent of their incomes. As the demand for affordable housing is high, Princeton & District Community Services Society assesses each applicant’s need for housing based on criteria which includes the applicant’s income, current living situation and personal and family requirements as compared to other applicants. This ensures that priority is given to households in the greatest need.

Purpose of this Form

This application form is designed to collect specific information from applicants seeking affordable housing in accordance with section 26 (c) of the Freedom of Information and Protection of Privacy Act (the FOI Act). Princeton & District Community Services Society (PDCSS) will use this information to determine your eligibility for housing and the types of accommodation that best suit your needs.

Important information

In British Columbia affordable housing vacancies are limited. To increase your chances of obtaining housing, it is recommended that you apply for several developments or areas.

Please update your application if any of your information changes. You should try to update your application at least once every six months.

Please provide day and evening phone numbers, or the phone number of a contact person so that housing providers can contact you if a unit becomes available.

Once completed please return to:

Princeton & District Community Services Society

120 Veterans Blvd., PO Box 1960,

Princeton, BC V0X 1W0

Telephone: 250-295-6666  Fax: 250-295-6214

Email: [email protected]


    For assistance in completing this form, please contact PDCSS at 250-295-6666

    1. Applicant Information (Person(s) applying for accommodation)

    Last name

    First name

    Relationship to Applicant

    Date of Birth (dd/mm/yyyy)

    Gender Identity

    Born in Canada? (Y or N)

    Status in Canada

    2.Residential Address

    Apt #

    Street #

    Street Name


    Postal Code

    Mailing Address If different from home address

    Apt #

    Street #

    Street Name


    Postal Code

    3. Contact Information

    Note: By providing an authorized contact, you are giving permission for PDCSS to exchange information with that authorized contact in order to maintain and update your file. To remove an authorized contact, please contact PDCSS.


    Residents pay 30% of their monthly income.
    Rent is recalculated once a year.
    Add to this a meal, once per day at noon
    2 meal options to choose from per day, billed separately,
    As a hospitality charge of $235.00 per month. This is mandatory.

    4. Residence History
    Please provide information on where you have lived for the last five years. At least one reference (landlord or character) is required. If space is needed, attach a separate sheet.

    Have you previously lived in subsidized accommodation?
    If so, list the names on the tenancy:
    Building name and address:
    What were the dates of your residency? From To

    5. References (Optional)
    If you did not list a current or previous landlord in Question 5, please include a reference that has observed your character over a reasonable amount of time. Examples: employer, past employer, pastor, outreach worker or health worker.



    Phone Number

    6. Asset Information
    What is the total value of assets for adults in the household?


    Not Counted

    • Stocks, bonds, term deposits, mutual funds, and cash

    • Personal items such as vehicles, jewelry and furniture

    • Real estate equity (net value after mortgage

    • Bursaries or scholarships from educational institutes for
    any household member who is currently a student

    • Business equity in a private incorporated company
    including cash, GIC’s, bonds, stocks or real estate


    • TFSA

    * Please provide the suggested proof of assets documents as stated in the checklist*

    7. Income Information
    List all gross (before deductions) monthly income for household members. If required, attach a separate sheet.


    Income Source
    (employment, EI, pensions, Income Assistance, etc.)

    Gross Monthly Income ($)

    Disability Income? Y or N

    8. Current Accommodations
    8a. Are you renting?
    If you are renting, how much is your monthly rent payment?

    8b. Please describe your current living arrangements.

    8c. Have you received a legal Notice to End Tenancy?

    If yes, when do you have to move out by?
    *Please provide a copy of the Notice to End Tenancy form (if applicable) as stated in the Additional Documents section*

    8d. Is there anything else that you want to share with a potential landlord about your current living situation?

    9. Health & Mobility Information
    9a. Do you, or any members of your household, have challenges with stairs?
    How many? steps

    9b. Do you, or any member of your household, use a:
    Wheelchair? Scooter?

    If yes, who? Used inside the home?

    9c. Please only list health conditions that would affect your housing needs.

    Name of Household Member

    Health Condition or Disability

    9d. Please describe any health concerns that are affected by your current housing.

    9e. Please describe any special requirements or features that you may need in your housing (e.g., grab bars, near transit). Please note that special requirements or features may limit the number of units that you are eligible for.

    10. Housing Options
    10a. Are you willing to live in a non-smoking/vaping free building and sign a non-smoking agreement?

    10b. Are you willing to live in a pet free building and sign a no pet agreement?

    10c. Do you have a dog that is accredited under the “Guide Dog and Service Dog Act”?
    Please submit proof of guide dog accreditation (if applicable)

    11. Optional Supplemental Application (if applicable)
    Additional consideration may be given to applicants who
    • Are homeless;
    • Are fleeing domestic violence or abuse; or
    • Have a serious health condition that is affected by current housing.
    Applicants who meet these criteria can have a Supplemental Application form completed by a third-party verifier familiar with their situation. Please find a list of appropriate potential verifiers within the supplemental form.

    I/We declare:
    • This is my/our application; and
    • All the information in it is correct and complete to the best of my/our knowledge.
    I/We permit:
    • PDCSS to make any inquiries that are necessary to verify the information given in this application;
    • Any person, corporation or social agency to release to PDCSS any information pertinent to the assessment of my/our application;
    • Members of PDCSS to receive and exchange with credit bureaus and my/our previous landlords’ credit and other tenancy information about me/us, to be used in the decision-making process to provide me/us with housing;
    • The Ministry of Social Development and Poverty Reduction to release information to PDCSS regarding my/our income.
    I/We understand:
    • That, in accordance with section 33.2 (a) of the Freedom of Information and Protection of Privacy Act, the information on this application may be shared with other affordable Housing Providers in order to increase my/our opportunities for housing;
    • That this application is not an agreement on the part of PDCSS or its staff to provide me/us with housing;
    • That if I/we refuse two offers of housing, my/our application will be cancelled;
    • That if I/we are being considered for an available unit, Housing Providers will gather additional information in order to assess my/our ability to uphold the obligations of a tenancy agreement and it is my/our responsibility to provide or cause to be provided information requested to assist with this assessment;
    • That it is my/our responsibility to tell PDCSS of any changes to the information given in this application and to provide any supporting documents required;
    • That false information given by me/us may result in my/our application being cancelled from consideration;
    • That if I/we have deliberately worsened my/our current housing situation (e.g., terminated a tenancy for no reason) that my/our application may not be accepted or my/our current living situation may not be taken into consideration

    This application must be signed by all household members aged 19 and older.

    Purpose of this form: This form collects personal information for contact purposes and to determine eligibility for temporary housing.

    Please do not submit original documents. 


    • Proof of status in Canada for all household members
      • Copy of Canadian birth certificate(s) or Canadian passport(s) if born in Canada.
      • If not born in Canada, please provide one of the following:
    • Record of Landing (IMM1000) or Confirmation of Permanent Residence (IMM5292/IMM5688); or
    • Permanent Resident Card (front/back); or
    • Any immigration document showing the date landed and the immigration code; or
    • Canadian Citizenship Card, Canadian Citizenship Certificate, or Canadian Passport; or
    • Refugee Protection Claimant Document (RPCD) or Notice of Decision 
    • Proof of Current address and rent.
      • Copy of current rent receipt or recent rent increase notice; or
      • Copy of lease or tenancy agreement showing current rent amount.
    • Proof of income or disability assistance
    • If receiving income assistance or disability assistance from the Ministry of Social Development and Poverty Reduction: copy of cheque stub or confirmation of monthly assistance.
    • If employed: proof of current gross monthly income (last three consecutive cheque stubs or a letter from your employer)
    • Copies of cheque stubs, bank statements showing direct deposits of pensions, or other confirmation of income for any other income source, for the last three months.
    • Proof of assets
    • Copies of bank statements or letter from financial institution stating total value of asset(s).
    • Property tax assessments for value of property owned and proof of outstanding mortgage(s) if you own property.

    Additional Documents (if applicable)

    • Copy of Notice to End Tenancy (if applicable)
    • Optional: Supplemental Application Form only needs to be completed if you wish to receive extra consideration for:
    • Homelessness;
    • Health condition affected by current housing; or
    • Fleeing abuse or violence.

    The Supplemental Application Form is available at the PDCSS office.


    Do not send original documents. Submitted documents will not be returned.

    Please review this checklist and make sure that, when this application is sent in, all documents are included. Missing information will delay the processing of your application.

    Submit your completed application with supporting documents:

    In Person: By Mail: Email: [email protected]
    PDCSS PDCSS Fax: (250)295-6214
    120 Veteran’s Blvd. Box 1960
    Princeton, BC Princeton, BC
    V0X 1W0 V0X 1W0