SHR: FOR OFFICE USE ONLY
File: Date:
Supportive Housing Registry
Transfer Request Form
This form should be completed by current residents of supportive housing who
wish to move to another supportive housing building.
1. Applicant: Please tell us about yourself. Please Print Clearly
Last Name First Name(s) Alias or Nickname (Optional)
Birth Date (dd/mm/yyyy) Gender
2. Where do you live now?
Development Name: Unit #:
3. How can we reach you?
Your Phone # Your Email Address
Your Address or an address you can receive mail (if applicable)
3a. Is there anyone we can leave a message with in order to contact you? Provide as many options as possible.
Contact or
Organization Name
Phone Number Email
Contact’s relationship
to you
*Authorized
Contact (Yes/No)
*By saying Yes under Authorized Contact, you are confirming that you have the contact’s permission to provide their information and you are giving permission for the
Supportive Housing Registry and any supportive housing provider to exchange information with that contact in order to maintain and update your transfer request.
Authorized Contacts can be added or removed by contacting the Supportive Housing Registry.
4
.
Why do you
need or
want to move?
5
.
Let us know if you have any difficulty with stairs or use a wheelchair.
Stairs are OK No Stairs Limited number of stairs. How many? ________
Do you require wheelchair accessible housing? Yes No
6. Do you have any pets? Yes No If Yes, how many? What kind? _________
Do you have a registered therapy or service animal? Yes No If Yes, please describe: _________
7. Where do you want to move?
Cities or Towns Neighbourhoods Buildings
For assistance completing this form, please call 604-433-2218; or toll free 1-800-257-7756 SHR-004 (2020-02-06) Page 1
DECLARATION & CONSENT
–
PLEASE READ AND SIGN
I declare:
This is my application to be considered for a transfer within supportive housing and all the information in it is
true, correct and complete.
I consent:
To BC Housing sharing my information with supportive housing providers, health authorities, shelter
providers, outreach providers, and/or other organizations partnering with BC Housing to coordinate access
to suitable housing for me.
To supportive housing providers, health authorities, shelter providers, and/or outreach providers who are
directly involved in finding suitable housing for me to make any necessary inquiries to verify the information
given in this application; and, for any person, corporation or social agency to release any necessary
information to the assessment of my eligibility for supportive housing.
To members of the Supportive Housing Registry to exchange information with my Authorized Contact(s) in
order to maintain and update my transfer application.
I understand:
This application is not an agreement on the part of the Supportive Housing Registry or supportive housing
providers to provide me with a transfer within supportive housing.
If I move out of my current supportive housing unit, my transfer application will be cancelled.
If there is a unit available and I cannot be contacted, the Supportive Housing Registry will offer the unit to
another applicant.
If I am being considered for an available unit, I may be asked to provide additional information to assess if
the supports provided in that building will meet my needs and it is my responsibility to provide or cause to
be provided information requested to assist with this assessment.
If I wish to withdraw this Declaration and Consent, I may do so at any time by contacting the Supportive
Housing Registry; however, withdrawal will result in the cancellation of my transfer request.
Resident Name (Print) Resident Signature Date
Next Steps:
Sign & Date Transfer Form
Submit Transfer Request Form:
Drop off the form with your housing provider to be forwarded to BC Housing: or,
Mail to Supportive Housing Registry, BC Housing, 101 – 4555 Kingsway, Burnaby, BC V5H 4V8.
Purpose of this form:
Personal information is collected on this form to identify and contact you, to assess your eligibility for supportive housing and to determine the
housing that meets your needs. The information is collected in accordance with section 26(c) of the Freedom of Information and Protection of
Privacy Act. If you have any questions about your personal information, please call or write the Privacy Officer at BC Housing, 1701 - 4555
Kingsway, Burnaby, BC, V5H 4V8, 604-433-1711.
Office Use Only:
HIFIS: No Yes - File #: Processed by:
Date:
Transfer Approved: Please select primary reason for transfer:
Change in support needs Closer to family/friends and/or supports
C
hange of community
H
ealth needs (i
.
e
.
: mobility, mental health)
Other describe:
For assistance completing this form, please call 604-433-2218; or toll free 1-800-257-7756 SHR-004 (2020-02-06) Page 2