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Chalet Malouin Inc.
Home
News / Events
Assisted Living / Supportive Housing
Online Application
Donate Today
Board of Directors
Contact Us
Kitchen Menu
Amenities
Hair Salon
Valley Fiber Cable & Internet
COVID Restriction Regulations
Job Postings
Email us at: admin@chaletmalouin.com or call us at 1-204-347-5753 for more information.
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
*
Marrital Status
*
choose one
Married
Seperated
Widowed
Single
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.
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Assisted & Supportive Care
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Home
News / Events
Assisted Living / Supportive Housing
Online Application
Donate Today
Board of Directors
Contact Us
Kitchen Menu
Amenities
Hair Salon
Valley Fiber Cable & Internet
COVID Restriction Regulations
Job Postings