Part 1: Application Form

Complete ALL questions, supplying ALL of the requested information.

The following information must be provided along with this form as it applies to you:

→ verification of income for all applicants

→ referral letter from previous Landlord (if currently renting)

→ Medical Assessment Form completed by your Doctor

→ Notice of Assessment from Revenue Canada from current income tax filed

Your application must be signed in the presence of a Commissioner for Oaths in and for the Province of Alberta. This service is provided at our office, free of charge, by appointment. Please call (403)627-3833 ext. 3

Application-Senior-Self-Contained.pdf

Part 2: Medical Form

Fully complete all fields. Print using legible characters. Incomplete applications will not be processed.

Return completed forms to:

Crestview Lodge

978 Hyde Street, Pincher Creek AB

Senior Self-Contained-Medical-Assessment.pdf