Express Lane: Online Questionnaire

Welcome to the AHSC ‘Express Lane’. Think of it as your online ‘drive-thru’. By completing the form below, you will speed up the process of getting your housing needs looked after. A follow-up phone call should occur very shortly after you complete the questionnaire. And, if you don’t hear back from us within a few days, don’t hesitate to phone, email, fax or ‘snail mail’ us to find out why!

Waiting for affordable, Rent Geared to Income (RGI), housing can take time and it requires a great deal of patience on your part. We would like to speed the process up as much as possible so please fill in the form below with as much information as you feel comfortable providing.

Contact Information

Name (required)

Address

City

Province

Postal Code

Phone number

Cell phone number

Email address (required)

Other Information

Sex

Date of birth

Are you Aboriginal? (required)

Please specify

Source of income

Household composition

How many children are there in the household?

Present housing status

Which shelter, if any, are you staying at?

What types of challenges are you faced with at present?
 Affordable housing Eviction Homelessness Budgeting Unemployment Parenting Addictions/substance abuse Affordable daycare Health problems Poor credit history Other