Apply for Service

We can provide advice or, sometimes, representation, for:

• eviction issues
• social assistance issues
• employment issues
• immigration issues

In order to qualify you must be receiving social assistance, such as Ontario Disability Support Program, Ontario Works, Employment Insurance or Canada Pension benefits.

Or, if you are working then your income must be below:

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Contact Information

Given Name(s)

Family Name(s) *

PronounsPlease selectShe/herHe/himThey/themOther

Other

Address

If you are at no current fixed address, please enter the closest intersection to your current location.

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Voicemail OK?

• Yes, you can leave voicemails at this number.

Email

Email Communications

• Yes, you can contact me by email.

Date of Birth

Preferred Contact Method: Email or Phone

Income

We can only help people with low incomes. However, if your income is too high, we may still be able to provide you with summary advice and discuss referral options.

What is your main source of family income?

• Employment
• Ontario Works (OW)
• Disability Support Program (ODSP)
• Canada Pension Plan (CPP)
• Old Age Security (OAS) plus Guaranteed Income Supplement (GIS)
• War Veterans Allowance
• Workers’ compensation benefits that are temporary or threatened
• Other

Other (specify)

Number of Adults in the Family

Number of Children

Approximate Total Monthly Family Income (you & other family members living with you)

Statistical Information

This information does not impact whether you receive assistance from us, and is only collected to help us better understand the communities we serve.

Gender IdentityPlease selectFemaleMaleAgenderTransgender FemaleTransgender MaleOther

Other (specify)

SexualityPlease selectGay/LesbianHeterosexualBi-sexualQueerTwo SpiritedOther

Other (specify)

Ethno-racial Identification *Please selectAboriginal/Indigenous (inside North America)Aboriginal/Indigenous (outside North America)African Ancestry – North AmericanAfrican Ancestry – CaribbeanAfrican Ancestry – Latin AmericanAfrican Ancestry – EuropeanAfrican Ancestry – Continental – North AfricaAfrican Ancestry – Continental – South AfricaAfrican Ancestry – Continental – East AfricaAfrican Ancestry – Continental – West AfricaLatin AmericanAsian – South AsianAsian – Southeast AsianAsian – West IndianAsian – FilipinoAsian – ChineseAsian – KoreanAsian – JapaneseMiddle Eastern – ArabMiddle Eastern – OtherWhite/Caucasian – North AmericanWhite/Caucasian – OtherUnknown/Choose not to identifyOther or Mixed Racial Heritage: Specify

Other (specify)

More Information

Special Needs/Accommodation Required

Language Spoken

• English
• Other

Other

Preferred Language

Interpreter Required

• Yes
• No

Area of Law

What sort of problem do you have? *

• Housing Law (eviction, repairs, harassment by landlord, rent subsidy taken away, discrimination)
• ODSP – Ontario Disability Support Program (denied, benefits cut off, overpayment)
• OW – Ontario Works (denied, benefits cut off, overpayment)
• CPP – Canada Pension Plan (retirement benefits or CPP disability benefits)
• Immigration
• Employment Law (wrongful dismissal, employment standards, EI, discrimination)
• Other

Type of property you live in?Please selectPrivate rentalCondominiumRent-subsidized unitCo-op

Your move in date?

Do you have a lease?Please selectYesNo

Do you share a kitchen or bathroom with your landlord?Please selectYesNo

Landlord’s name? *

Have you received any forms? If yes, what?

Date you received form

Is there a termination date? If yes, when?

Is there a hearing date? If yes, when?

Is there a Sheriff’s Notice to Vacate date? If yes, when?

Date you applied?

Date you received a denial letter?

What was the reason for denial?

Date you requested an Internal Review or deadline for Internal Review?

Have you received and Internal Review decision? Date received?

Date you filed an appeal to the Social Benefits Tribunal or deadline for filing?

Is there a hearing date scheduled? If yes, date?

Status in CanadaPlease selectCanadian citizenPermanent residentProtected Person / Convention RefugeeRefugee claimantWork permit (temporary resident)Study permitVisitorNo StatusOther

Your employer’s company name?

Your job title?

Were you unionized? Please selectYesNo

Your start date?

Your end date?

Are you currently working?Please selectYesNo

Is there any deadline? Please selectYesNo

Details of Issue

Brief description of problem *

Please attach copies of any documents relating to the problem. For example, an eviction notice or a letter from Ontario Works.

Click or drag files to this area to upload.You can upload up to 5 files.

Did Anyone Refer You to Us?

Referred By

Referring Staff Person (if an agency is supporting a client in completing this form)

Date / Time

Date

Time

Submit