Donate

Switchback

The name Switchback is a metaphorical reference to the sharp, 180-degree turns going up a mountain. It signifies a radical change in direction, a path that looks less than straight but leads eventually to the top of a mountain.

The Switchback houses youth and young adults between the ages of 16 and 24, with a history (past or present) of homelessness. The Switchback is not low incoming housing, but rather a two-year program where residents must be committed to engaging with staff to grow, develop, and learn from the essential life skills support that is offered.

The Switchback has support staff available to assist residents 24/7. There is a drug & alcohol counsellor, trauma counsellor and nurse practitioner available onsite.

Rent is $375.00 and covers all utilities. A $200.00 damage deposit is also required.

Application Form

The Switchback Supportive Housing for Youth & Young Adults

Application Form

Page 1 of 3

1. Applicant

Name*

Prefix

First

Last

Date of Birth*

mm/dd/yyyy or use calendar widget

Gender*

2. What city/town do you currently stay in?

City/Town*

How long have you been here?*

Current Address

3. How can we reach you?

Your Phone Number*

Your Email Address

Facebook Name

Is there anyone we can leave a message with in order to contact you?

1st Contact or Organization:

Contact or Organizaton Name

Phone Number

Email Address

Contacts relationship to you

Authorized Contact

* Authorized Contact?

Yes

2nd Contact or Organization:

Contact or Organization Name

Phone Number

Email Address

Contacts relationship to you

* Authorized Contact?

Yes

3rd Contact or Organization:

Contact or Organization Name

Phone Number

Email Address

Contacts relationship to you

* Authorized Contact?

Yes

Authorized Contact Permission Information:

*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 Switchback to exchange information with that contact in order to maintain and update your application. Authorized Contacts can be added or removed by contacting the Switchback.

IMPORTANT: If we are unable to contact you, we will move to the next applicant.

4. What are your sources of income?

On Income Assistance

YAG

Employment

No Income

LIst all sources and amounts. (if on income assistance, specify if employable, PWD or PPMB)

1st Income Source

Name

Amount (Monthly)

2nd Income Source

Name

Amount (Monthly)

3rd Income Source

Name

Amount (Monthly)

5. Current Living Situation

Please select the one option that best describes your current living situation:

Staying with friends or relatives

Treatment facility or detox

Sleeping outside

Hospital

At an emergency shelter

Private market - Single room occupancy

Correctional facility

Private market - own rental or suite

Other

If you chose Other, please specify your current living situation

How long have you been living like this?*

Is there a deadline to leave your current living situation?*

Yes

Date

If you chose Yes above, what is the date when you must leave your current living situation?

Why do you need or want to move?*

What is something you wish you could do, but can't because of your living situation?*

Have you ever stayed in a shelter?*

Yes

If Yes, which one(s)?

If no, why not?

Is there a shelter you prefer?

Yes

If Yes, which one and why?

6. Health and Wellness

Please describe in as much detail as you're willing to share.

Mental Health:

Physical Health:

Substance Use:

No health conditions

7. Justice System Involvement

Justice system involvement does not in itself impact the outcome of your application.

Are you currently on probation or bail?*

Yes

If Yes, what is the name and contact information of the officer you are required to report to?

Do you have any outstanding charges?*

Yes

Is there anything else you would like us to know?

DECLARATION AND CONSENT

I declare:*

This is my application to be considered for supportive housing and all the information in it is true, correct and complete.

I understand:*

That the Switchback program is a program agreement and not a tenancy agreement. There are certain expectations for the residents to maintain their placement in the program.

It is my responsibility to contact the Switchback at least once every month for my file to remain active.

If there is a unit available and I cannot be contacted, the Switchback will move on to the next applicatant.

If I am being considered for an available unit, I will be invited to the Switchback for an initial interview. At that time, I will be asked to provide additional information to find out if the program is the right fit for me.

If I wish to withdraw this Declaration and Consent, I may do so at any time by contacting the Switchback; however, withdrawal will result in my no longer being considered for placement.

Applicant Name*

Please indicate your accceptance of this Declaration and Consent form by filling in your name above.
PLEASE NOTE: YOU CANNOT SUBMIT THIS FORM UNLESS YOU AGREE TO ALl THE CONDITONS UNDER "I Declare" and "I Understand"

Date*

This field should be left blank