REACHING HOME AND POVERTY REDUCTION

Housing and Homelessness

Completed applications should be submitted to:

Reaching Home Email: reachinghome@mnbc.ca

By Canada Post to:

Housing & Homelessness Reaching Home Program – #380 - 13401 108 St Surrey, BC V3T 5T3

For more information, please contact MNBC at Toll-Free 1-800-940-1150 or 604-557-5851 EXT 8278

Declaration of Truth and Consent:

Declaration:

• The applicant declares that all the information given in this application form is true and
complete.

• The applicant acknowledges and agrees that the facts given in this application form will be kept
and disposed of as required by the Information Management Act.

• The applicant(s) understands that this application does not obligate MNBC to approve funding.

Consent:

• The applicant(s) does 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. 1). To confirm household income; 2). To confirm eligibility for program funding;
3). for audit purposes. 4). Referral to other program within MNBC or outside service providers.

• The applicant(s) does give consent to release of information comply with the BC Personal
Information Protection Act (PIPA) and Freedom of Information and Protection of Privacy Act
(FIPPA).

• The applicant agrees that MNBC may collect data and contact them from time to time for the
purpose of conducting any client- related surveys.
CONSENT AND SIGNATURE OF APPLICANT:

Signature:

Date:

*Indicates mandatory information and must be filled.

APPLICATION

*Applicant(s) Full Legal Name:

Ashley Lehman
Address:
302-32124 Tim's ave
How long have you been at this address? If no
Since last august
fixed address, how long have you been
experiencing homelessness?

Email:
Ashleylehman37@gmail.com
Phone Number:
6042260721
Date of Birth:
04/19/1994
Gender:
Female
Social Insurance Number:
753996818
*MNBC Citizenship Number:
Working on getting it
Community Card Number:

Do you self-identify as Métis?

Yes
What is your monthly income?
2100
Are you currently an employee of MNBC?
No
Have you applied for other programs or services
No I don't think so
with MNBC?