Application

Applicants

Applicant Name(Required)

First Last

Birthday(Required)

MM slash DD slash YYYY

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Second Applicant Name

If Applicable

First Last

Second Applicant Birthday

MM slash DD slash YYYY

Household Composition

Person 1

Person 1 Name

First Last

Person 1 Age

Please enter a number from 1 to 120.

Person 1 Relationship to Applicant

Person 2

Person 2 Name

First Last

Person 2 Age

Please enter a number from 1 to 120.

Person 2 Relationship to Applicant

Person 3

Person 3 Name

First Last

Person 3 Age

Please enter a number from 1 to 120.

Person 3 Relationship to Applicant

Person 4

Person 4 Name

First Last

Person 4 Age

Please enter a number from 1 to 120.

Person 4 Relationship to Applicant

Accommodation Profile

Current Housing Situation(Required)

Own Home

Rental

Staying with Friend/Family

No Fixed Address

Other

Currently live in(Required)

Cochrane

Beaupre

Bearspaw

Bottrel

Bragg Creek

Springbank

Other

How long have you lived at your current address?(Required)

Have you lived in Cochrane?(Required)

Yes

When and for how long?(Required)

Current Reasons for requiring housing (check all boxes that apply)

Overcrowded/Too small

Divorce/separation

Physical disability/accessibility

Domestic Violence

Unsafe

Health concerns

Landlord/tenant issue

Lost Job

Eviction

Poor repair

Too costly

Living in vehicle

Addiction/mental health

Living in Camper or tent

Other

Other Reason for requiring housing?(Required)

Prefer to live in?(Required)

Downtown Cochrane

Sunset

William Street

Size of unit requested(Required)

Bachelor

1 Bedroom

2 Bedrooms

3 Bedrooms

Please Note the total household income (line 150 on your income tax return) cannot exceed the ‘Core Need Income Thresholds for a particular unit size. The 2025 CNIT for Cochrane: Studio: $54,000 1 bedroom: $65,000 2 bedroom: $77,000 3 bedroom $85,000

Do you need a Wheelchair accessible unit?(Required)

Yes

Does anyone in your household smoke?(Required)

Smoking of any product is NOT permitted in CSHO units

Yes

Are you employed?(Required)

Yes

Current Employer/Occupation(Required)

Where do you work?(Required)

Cochrane

Calgary

Other

Monthly Income

Full time employment

Part time employment

Self-employment

Casual employment

Student

Employment Insurance

AISH/Disability Pension

Alberta Works

Retired Pension

Other

Not employed?

looking for work

not looking for work

Total Monthly Income from all Sources

Annual Total Income(Required)

Less than $15,000 $15,000-$30,000

30,000- $61,000

$61,000 or more

Do you have a support network in Cochrane?(Required)

Yes

Please explain your support netowrk(Required)

If you would like to be connected with a Community Resource Worker through FCSS or FRN, please call 403-851-2250 or email fcss@cochrane.ca

Declaration

The information you provide to the Cochrane Society for Housing Options (CSHO) will:

Be treated in a confidential manner and will not be used for any other purpose unless specifically authorized by the applicant.
Be used for the purpose of evaluation and eligibility of the applicant to the CSHO affordable housing program.

Both the Cochrane Society for Housing Options and the applicant acknowledge that provisions in the Freedom of Information and Protection Act are applicable regarding the collection, use and release of this information.

By signing this declaration, you are providing consent for Cochrane Society for Housing Options and the Cochrane Family & Community Support Services (FCSS) and Family Resource Network (FRN) to share information related to affordable housing in order to improve effectiveness of the service being provided to you.

Consent

I agree, consent and give the Cochrane Society for Housing Options permission to use my non-identifying information for the purpose of data collection and improved service delivery. By clicking submit you agree that all the above information is correct.

Application

Am I Eligible?

Contact Information

Applicants

Household Composition

Person 1

Person 2

Person 3

Person 4

Accommodation Profile

Monthly Income

Declaration

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