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    • St. Josaphats
    • St. Nicholas
    • Father Hannas
    • Barvinok
    • Grove Manor
  • Community
    • Volunteer With Us!
    • Adult Day Support Program
    • Mobile X-Ray Services
    • Hope Medical Clinic & Family Health Centre
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      • Menu
      • Facility Rental FAQs
    • Baba’s Own
  • About
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    • Publications
    • Donate To Seniors Care
  • Events
    • 2025 Fenwyck Heights Open House
    • 2025 Wound Care Fair
    • 2025 This is Home
    • 2025 Wound Care Workshop
  • Contact Us

New Tenant Application

"*" indicates required fields

Please indicate which building you are submitting an application for:

St. Josaphat's Senior's Residence*
9637 - 108 Ave
Edmonton, AB T5H 4G4
780-472-4545
Fr Hannas Seniors' Apartments*
10809-70 Ave
Edmonton, AB T6H 4Y5
780-472-4545
St. Nicholas Seniors' Home*
5619-98 Ave
Edmonton, AB T6A 3Y5
780-472-4545
Barvinok Seniors' Apartment*
3625-116 Ave
Edmonton, AB T5W 0W7
780-472-4545

Primary Applicant Information

Full Name*
MM slash DD slash YYYY

Citizenship Status

Canadian Citizen*
Permanent Resident*
Privately Sponsored*

General Details

Martial Status*
Interpreter Required?*
Do you smoke?*
Do you have a criminal record?*

Secondary Applicant (if applicable)

Would you like to add a Second Applicant?*
Full Name*
MM slash DD slash YYYY

Citizenship Status

Canadian Citizen*
Permanent Resident*
Privately Sponsored*

General Details

Martial Status*
Interpreter Required?*
Do you smoke?*
Do you have a pet?*

Parking

(There are wait lists at some buildings.)
Do you require parking?*

Alternative Contact Person

Name

Current Accommodation

Status of Accommodation*
Have you received a notice of vacate?*
(If Yes, please include copy of Notice Vacate)
Accepted file types: jpg, png, pdf, Max. file size: 25 MB.
Do you have a previous landlord?*
(If you have rented at your current rental for less than 2 years, please complete this section)

Current Monthly Payments

Financial Information

This information is mandatory in order to be considered for seniors' self-contained apartments.

Primary Applicant

Secondary Applicant

Apartment Accommodation

Bedroom Type*
Do you require wheelchair accessibility?*
MM slash DD slash YYYY

Other Information

MM slash DD slash YYYY
MM slash DD slash YYYY
I authorize the Department of Seniors, Community and Social Services to collect my personal information directly from St. Michael’s Healthcare Services for the purpose of administering provincially funded affordable housing programs.

Personal information on this form is collected under Alberta's Freedom of Information and Protection of Privacy Act. Questions concerning the collection, use and disposal of this information should be directed to St. Michael’s Healthcare Services.

St. Michael’s Health Group
7404 139 AVE NW
Edmonton AB T5C 3H7
  • 780-473-5621
  • 780-472-4506
  • 1-800-472-6169
  • smeccs@smhg.ca

  • All Rights Reserved. 2023 SMHG
    Registered Charitable #108032483 RR0001

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Heritage Hall

  • 780-472-4508
  • hall@smhg.ca

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  • MM slash DD slash YYYY

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St. Michael's Health Group

  • 780-472-4508
  • 780-472-4785
  • 1-800-472-6169
  • smeccs@smhg.ca

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