APPLICATION FORM 1) General information:Last name: First name: Date of birth: Spouse's name: Spouse's date of birth: Address: Town/City: Postal Code: Telephone: Cellular: Email: 2) Information: Contact person (if other than the applicant)Family name: First name: Address: Town/City: Telephone: Cellular: Email: 3) Motivation:What is the main reason you would like to move to Villa Youville? 4) When do you hope to be able to be able to live at Villa Youville? As soon as possibleIn 1 to 5 yearsNot before 5 years 5) Francophone:I am francophone: yesnoMy spouse is francophone: yesno 6) Accommodation preference:Studio (bachelor) MOTEL 1MOTEL 111 bedroom MOTEL 1MOTEL 11MOTEL 111PAVILLON2 bedrooms MOTEL 1MOTEL 111Please indicate your preference 7) Mandatory declaration for applicants *I declare that the information provided is correct and truthful to the best of my knowledge; I acknowledge that this application in no way obliges Villa Youville to provide me with a lodging accommodation; I understand that the independent living (Motels) is subsidized (low-income) housing and subject to a maximum household income of$53,000 annually. I acknowledge that Villa Youville incorporated is a Francophone establishment and I freely accept to respect the linguistic and cultural values of the establishment as long as I stay at Villa Youville.yesnoApplicant Date VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: