Vancouver Resource Society: Housing Form

The Vancouver Resource Society offers a wide range of housing options, care models and services that allow people with disabilities to live in the community.

Please check below the program you wish to apply for:

	Independent Apartment Living Program - live in your own apartment with 24-hour on-call attendant care
	Independent Shared Living Program - group homes
	Assisted Living Program - group home for individuals who require assistance with daily decision-making
	Children's Program - for disabled children, funded through the Ministry of Children and Families
	Housing Placement Service
	Volunteer Program

First name:

Last name:

E-mail address:

Mailing address:

City:

Postal code:

Phone number:

Fax number:

What size of unit are you applying for?

WheelChair? Yes No
If Yes, is it a

Require wheel-in shower? Yes No

Do you require attendant care? Yes No
If Yes, how many hours per week of care are you assessed for?

How is your care funded?

Gender of caregiver required

Other people living in the unit?
If Children, how many?

Do you smoke? Yes No

Do you have a pet? Yes No

Enter your Questions or Comments:

THANK YOU!

Vancouver Resource Society
#310 - 2006 West 10th Ave., Vancouver, B.C. V6J 2B3
Tel: (604) 731-1020 Fax: (604) 731-4003 E-mail: vanres@vrs.org

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