How to Apply

3 WAYS TO APPLY FOR RESIDENCY:

(See all options below)

1) Download and print the PDF version of the application below
(Available in both English and French)
The printed & completed copy of PDF can be scanned and emailed back
to: [email protected] or dropped off at our admin office

2) On-Line application:
Please complete the On-Line application (below) with as much details as possible and hit "Submit"

Chalet Malouin
Online Housing Application

* Indicates required field

Applicant's Name *

First

Last

Co-Applicant's Name *

First

Last

Applicant's Date of Birth *

Applicant's Address *

Line 1

Line 2

City

State

Zip Code

Country

Co-Applicant's Date of Birth *

Home Phone Number *

Marital Status *

Emergency Contact or Person Responsible *

First

Last

Home Phone Number *

Contact Person's Address *

Line 1

Line 2

City

State

Zip Code

Country

Work Phone Number *

Cell Phone Number *

Email *

Type of room that you would prefer *

Bachelor - Elderly Person Housing One Bedroom - Elderly Person Housing Two Bedroom - Elderly Person Housing Bachelor - Assisted Living Bachelor - Supportive Housing Adjoining Bachelor Apartments- Assisted Living/Supportive Housing

Are you currently receiving Home Care Services? *

Yes, I am currently receiving Home Care Services. No, I am not currently receiving Home Care Services.

Submit