Skip to Content

Text size:

Français

Contrast color scheme:

About
Intervenor Services
Housing
Training
- Programs
- Fees For Service
Emergency Intervenor Services
Resources
Ways To Give
150 Eighth Street
CHKC Camp
Contact Us

Donate

close

Housing

Accessible Housing

Rotary Cheshire Apartments (RCA) is a barrier-free building with 16 one bedroom apartments. The building and apartments include the following features:

Contrasting colours on walls, doors, flooring, electrical outlets, switches, door handles, etc.
Tactile surface alerts
Alerting systems with loud horns, vibration and strobe lights for emergencies, door bells, telephones, etc.
Tactile signage with raised print and Braille
Matte surfaces to minimize glare and evenly distributed lighting
Accessible enterphone system
Common room, public washrooms

Click here for 150 Eighth Street Housing Application

Canadian Helen Keller Centre Housing Application with Intervenor Services

Downloadable PDF

Please enable JavaScript in your browser to complete this form.

Name *

Home Phone/TTY Number *

Street Address *

Apt. Number

City *

Province *

Email *

Name

Phone Number

Relationship

If from an Agency, Name of Agency

Are you over the age of 18 years? *

Yes
No

Date of Birth *

Are you visually impaired/blind? *

Yes
No

Are you hearing impaired/deaf? *

Yes
No

How do you communicate expressively and receptively? *

How do you prefer hard copy information? (i.e. braille, large print, regular print) *

Can your vision report and hearing report be made available upon request? *

Yes
No

Do you require the use of an Intervenor for communication or are you able to communicate in most situations without an Intervenor? *

I require an intervenor
I do not require an intervenor

Please list the activities you may use an Intervenor for

Are you willing to use an Intervenor at least three times per week (minimum of 10 hours)? *

Yes
No

Do you currently receive Intervenor Services from any other agency? *

Yes
No

If yes, please state the agency name and how many hours per week you receive service from them.

Are you able to travel independently? Do you require guiding? Do you use a white cane? Please explain. *

Name

Relationship to you

Date of Birth

Gender

Status in Canada (citizen, landed immigrant, refugee claimant)

Are you able to live independently without support services? *

Yes
No

What does living independently mean to you, and have you ever received any skills training? (O&M, ADL, computer literacy, etc.) *

Do you require housing where additional support services other than Intervenor Services are available? (i.e. Nursing, Attendant Care Services) *

Yes
No

If yes, please state which additional support services you require

Do you use support services other than Intervenor services? *

Yes
No

If yes, please state which support services you require

Is there a personal situation that makes your need for housing urgent? *

Income Source *

Type of Asset *

Previous Address *

Apt. Number

City *

Date Moved In *

Date you Moved Out *

Why did you move out? *

Landlord's name/Agency *

Landlord's Address *

Landlord's City *

Landlord's Province *

Landlord's Telephone Number *

Have you or anyone in your household, ever lived in subsidized housing anywhere in Ontario? *

Yes
No

Name of person who lived in subsidized housing

Name and address of housing provider

City

Postal Code

Date moved in

Date moved out

Why did you/they move out?

Does anyone in your household owe money to the above or to any other subsidized housing provider?

Yes
No

If yes, indicate amount owing

Please explain why you would like to live at Rotary Cheshire Apartments and list any other important information about yourself, family, you disability, current housing situation, need for Intervenor Services, etc. that may be important for the purpose of this application. *

Applicant's Signature *

Spouse's/Co-applicant's signature

Date *

Applicant's Signature *

Spouse's/Co-applicant's signature

Date *

About Us
Intervenor Services
422 Willowdale Ave.
Ways To Give
Contact Us

Join us on Facebook

Follow Us on Twitter

Instagram with us!