Special Priority Application Package Information Sheet

Transcription

1 Special Priority Application Package Information Sheet If this information is required in an accessible format, please call extension 245. In order to apply for Special Priority status on the centralized waiting list, you must complete both parts of the Special Priority Application. These are the: Declaration of Abuse Verification Record This Application must be completed in addition to the Application for RGI Assistance. What is Special Priority Status? Households that are eligible for rent-geared-to-income (RGI) assistance are generally placed on the centralized waiting list in the order that they apply. This means that the earliest applicants will normally be offered housing first. However, you may be moved to a higher place on the centralized waiting list if you are currently living with someone who is abusing you, or you have recently stopped living with someone who was abusing you. This is called Special Priority status. Special Priority status is intended to help you separate permanently from someone who is abusing you. It is given to applicants whose personal or family s safety is at risk, and does not apply to applicants who simply want to separate from someone because the relationship is not working. Who is Eligible for Special Priority Status? In order to qualify for Special Priority Status, you must first be eligible for RGI assistance. If you are eligible for RGI assistance, you may also be given Special Priority status on the waiting list if: You are currently living with someone that is abusing you or another person in your household. You used to live with someone who was abusing you or another person in your household, and stopped living with them three months ago or less. In some circumstances, you may still be considered for Special Priority status if you have been separated for longer than 3 months. You are a sponsored immigrant, and your sponsor is abusing you or another person in your household. You must also provide the attached Verification Record as proof of your Declaration of Abuse, as well as written proof that you are living with or used to live with the person who is abusing you.

2 Proof of cohabitation: Please ensure that documentation for the verification of co-residency that you and the person named as the abuser lived at the same residence within the last 3 months is provided as part of your Request for Special Priority Status. One of the following documents (identifying the name and address of the abuser) can be used in combination with evidence that the SPP applicant also resides or resided at that address. Alternatively an address record is provided with the names of the victim and the abuser. More than one piece of documentation may be required when information is conflicting. Child Tax Credit Condominium fees Credit card statements/utility bills/loan documents Employment Insurance statements/documents Income Tax Statement/Assessment Insurance policy documents and/or premium receipts Joint assets/rrsp statements/document Land registry records Lease or rental agreement Mortgage statement/documents Ontario Works or Ontario Disability Support Program statements (drug or dental card or letter from your worker) OSAP statements/documents Property deeds Property taxes School registration Statement from a Bank Subsidized day-care documents Ontario Driver s License Notice of rent increase or decrease Rent receipt or letter from the landlord with their name, address and phone number with applicant's or abuser s address on it along with the timeframe association with your co-residency Please note: This list is not all-inclusive or exhaustive. It provides a sample of what documents may be accepted by Housing Access Centre as proof of cohabitation. Other documents may be accepted if: (1) it reflects the same full address when the client and alleged abuser resided together when the abuse took place (2) is dated within the time period preceding the date the client s application is submitted to HAC (3) includes the client and alleged abuser s full names (separate documents may be submitted if the client and abuser did not have joint assets), and (4) it is obtained from an unbiased source. If none of the above documents are available, we will discuss other options with you directly. Notice with Respect to the Collection of Personal Information: Municipal Freedom of Information an Protection of Privacy Act This information is collected under the legal authority of the Housing Services Act, 2011 for the purpose of administering the social housing programs prescribed in this Act and its associated Regulations. Questions about this collection should be forwarded to the Director of Social Services, City of Stratford at 82 Erie Street, Stratford ON N5A 2M4 (519) or

3 Special Priority Application - Declaration of Abuse Form 103 This declaration is to be completed by the Applicant for Special Priority status. Applicant s Name: I DECLARE that I have been abused by: Name of person: Relationship to person: I lived with my abuser at the following address: I DECLARE that I intend to permanently live apart from my abuser and that: I am currently living with this person I have not lived with this person since I have never lived with this person, Date This person is my Canada Immigration sponsor. If you have not lived with this person within the last three months, please indicate why you have not applied for Special Priority status until now: I HAVE ATTACHED proof that I live with or have lived with this person (e.g. copy of lease, rent receipts, utility bills). This is mandatory. I REQUEST Special Priority on the centralized waiting list for rent-geared-to-income (RGI) assistance. I CONSENT to the destruction of the Verification Record and all supporting documentation if I become ineligible for RGI assistance or become housed. I CONSENT to the disclosure to the City of Stratford of the Verification Record and any other information or documents it may request to verify this Declaration in order to determine my eligibility for Special Priority status. Applicant s signature: Date: (YYYY/MM/DD) If the applicant for Special Priority status is under the age of 16 and you are signing this form on their behalf as their parent, guardian or power of attorney, please provide the following: Your name: Relationship to applicant: Page 1

4 Special Priority Application Verification Record Form 103 This Verification Record is to be completed by a person who knows the Applicant for Special Priority status and can confirm their Declaration of Abuse. Name of Special Priority Applicant: Name of Person Completing Verification Record: Organization: Position: Address: Telephone Number: I DECLARE that I know the applicant in my professional role as a (please check): doctor law enforcement officer social worker community health care worker lawyer member of the clergy social service worker settlement services worker teacher guidance counsellor victim services worker community legal worker nurse social housing provider shelter worker community services worker I DECLARE that I am not working in one of the above roles, but that I have direct knowledge that the applicant has been subject to abuse. (If you check this option, you must provide a letter supporting your statements below as well as a declaration of the truth of this record as administered by a commissioner for taking affidavits.) I DECLARE that: the abuser has made one or more attempts to kill the applicant or another member of the household the abuser has used a weapon against the member or another member of the household the abuser has physically injured the applicant the abuser has forced the applicant to engage in sexual activity against his or her will the abuser has forced the applicant to perform degrading or humiliating acts the abuser has failed to provide or has withheld the necessities of life the abuser has threatened to kill the applicant or another member of the household the abuser has threatened to use a weapon against the applicant or another member of the household Please complete BOTH sides Page 2

5 the abuser has threatened to physically harm the applicant or another member of the household the abuser has destroyed or injured the applicant's property or threatened to destroy or injure the applicant's property the abuser has intentionally killed or injured pets or threatened to intentionally kill or injure pets the abuser has threatened to harm or remove the applicant's children from the household the abuser has threatened to prevent the applicant from having access to their children the abuser has threatened to withdraw their immigration sponsorship the abuser has threatened to have the applicant deported the abuser has enforced social isolation upon the applicant the abuser has terrorized the applicant the abuser has stalked or harassed the applicant or another member of the household the abuser has undue or unwarranted control over the applicant's daily personal or financial activities there has been police intervention as a result of the abuse The abuser has otherwise threatened the applicant by doing (please state): The abuser has led the applicant to fear for his or her safety by doing (please state): I have ATTACHED as VERIFICATION: a letter supporting the above noted statements (mandatory for anyone completing this verification record) a declaration of the truth of this record as administered by a commissioner for taking affidavits (required only if you do not work in a professional capacity with the applicant). I DECLARE that the information that I have provided in this form and any supporting documentation is an accurate account of the applicant s situation. Signature of person completing Verification Record: Date: Housing Office Use Only Date Received (YYYY/MM/DD): Received by: Approved Denied Date (YYYY/MM/DD): Signature : Page 3