Please indicate which building you are submitting an application for:
Primary Applicant Information
Secondary Applicant (if applicable)
(There are wait lists at some buildings.)
Alternative Contact Person
Current Monthly Payments
This information is mandatory in order to be considered for seniors' self-contained apartments.
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