Senior Housing Application - The Grande Spirit Foundation

Grande Spirit Foundation

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9505 102 Ave, Grande Prairie, AB T8V 7G9 (780) 532-2905 info@grandespirit.org

Home
About
Opportunities
Housing
Applications
Contact
- Upcoming Events
- Maintenance Request

Primary Applicant Title *Please fill the required field.

Primary Applicant First Name *Please fill the required field.

Primary Applicant Last Name *Please fill the required field.

Primary Applicant Cell Phone *Please fill the required field.

Primary Applicant Home Phone

Applicant Health Care # *Please fill the required field.

Primary Applicant Mailing Address *Please fill the required field.

Primary Applicant Birthdate *Please fill the required field.

Primary Applicant Citizenship

Length of Residence in Grande Prairie/Community/Area *Please fill the required field.

Length of Residence in Alberta *Please fill the required field.

Co-Applicant Title

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Cell Phone

Co-Applicant Home Phone

Co-Applicant Health Care #

Co-Applicant Mailing Address

Co-Applicant Birthdate

Co-Applicant Citizenship

Co-Applicant Length of Residence in Grande Prairie/Community/Area

Co-Applicant Length of Residence in Alberta

Are you applying for: Please check your preference(s) *

Lodge (Full Service)

Enhanced Appartment (Meals are available)

Self-Contained Apartment (Independent)

Preferred Facility 1 *Please fill the required field.

Preferred Facility 2 *Please fill the required field.

Preferred Facility 3 *Please fill the required field.

Are you currently a resident with Grande Spirit Foundation? *

Yes

No

If No where do you currently live?

Are you currently receiving a rental subsidy through the Grande Spirit Foundation? *

Yes

No

Have you resided with Grande Spirit Foundation in the past? *

Yes

No

Have you been evicted?

Yes

No

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin / Emergency (Would you like this person to be the first point of contact for this applicant?)

YES

NO

Next of Kin Cellphone

Next of Kin Home Phone

Next of Kin Email

Next of Kin Mailing Address

APPLICANT SIGNATURE *Please fill the required field.

Application Date *Please fill the required field.

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Grande Spirit Foundation Administration Office
9505-102 Ave
Grande Prairie, AB
T8V 7G9

Grande Spirit Foundation
Family Housing Office
9503-102 Ave
Grande Prairie, AB
T8V 7G9

Phone: 780-532-2905
Phone: 780-539-3155

Email: info@grandespirit.org
Email: seniors@grandespirit.org

Copyright © The Grande Spirit Foundation 2024.