Application for Family Housing

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Personal information on this form is collected under the Provincial Health Number Act R.S.P.E.I. 1988, Cap. P-27.01 and section 31 of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01, as it relates directly to and is necessary for the provision of the Seniors Home Repair Program. If you have any questions about this collection of personal information, you may contact the Department of Family and Human Services at 1-902-368-5770.

Identification
For example C1B 0X1 or 12345
For example 902-555-5555