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NO SPACE FOR HATE

Housing Application

YOUR OWN DETAILS:

First name

Last name

How can we contact you?

Gender Identity

Are you currently navigating the criminal justice system or exiting a correctional facility?

Are you navigating homelessness or have you been homeless in the past 30 days?

Cultural/ Racial Identity

Date of Birth

Do you have an income source? (Income assistance, CPP, employed)

Do you have an email?

Thanks for submitting!
We’ll be in touch within 2 weeks

(902) 422-6417 | admin@coverdale.ca

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6169 Quinpool Rd Suite 221B

Halifax, NS

B3L 4P8

©2023 by Coverdale Justice Society

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