Welcome Home Kits Program Online Application

First Name

Middle

Last Name

Phone

Date of Birth

Address

Address 2

City/Town

ZIP/Postal Code

MNBC Citizenship Number (If Applicable)

Do you self-identify as Métis?

Have you applied for other programs or services at MNBC? If yes, please provide the name or type of program.

What is your reason for applying? (please identify how you are transitioning, or have recently transitioned to a more stable living situation)

Is there a Walmart or Save-On foods in your community? (List address if possible)

What are the best days of the week and times for you to receive a delivery?

Is there any information we should provide to a delivery driver about accessing the property where you are living?

Applying As: Check All That Apply

Individual/Family has experienced homelessness or is preciously housed.

Seniors experiencing homelessness or are precariously housed.

Women/Women and their children fleeing violence.

Men/Women/Youth staying in emergency shelters or safe houses.

Youth

LGBTQ2S+

Indigenous families and individuals.

Persons with disabilities and health and activity limitations.

Individuals in recovery.

Individuals relying on rent bank/food bank assistance.

Individuals living in housing encampments or in the street.

Individuals who are sofa-surfing, precariously housed or unhoused.

Individuals leaving jails, hospitals, or other institutions.

Youth aging out of care.

Other

Annual Household Income

This program is available to all Métis citizens and/or self-identifying Métis individuals meeting one or more requirements above.

I declare that all the information given in this application form is true and complete and that this information is factual and true.
I give consent to MNBC and its agents to investigate and disclose any of the facts given in this application form for internal purposes or to other agencies for any of these reasons:

To confirm identity.
To confirm enrollment/registration.
Agree to reimburse MNBC the full amount of funding if they have not made full and accurate disclosure of information.
Acknowledge and agree that the facts given in this application form will be kept and disposed of as required by the Information Management Act.
Agree that MNBC may collect data and contact them from time to time for the purpose of conducting any client-related surveys about Programs.
Understand that this application does not obligate MNBC to approve funding.
Understand that all applicants who give personal information to MNBC shall be required to consent to the release of that information to MNBC in order to comply with the BC Personal Information Protection Act (PIPA) and Freedom of Information and Protection of Privacy Act (FIPPA).

Signature

Sign above

Date of Signature