Current Page 1 Page 2 Preview Personal Information on this form is collected under the Provincial Health Number Act and Section 31 of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15.01, as it relates directly to the approval of your application. If you have any questions about the collection of your personal information call 1-855-374-7366. Identification Is your combined annual household income $50,000 or less? - Select -YesNo Is the property your principle residence and do you currently reside in the home? - Select -YesNo You are not eligible for this program. Do not fill out the rest of this form. Enter your full name including middle name(s) and your mailing address in the fields below. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Other Telephone Number For example 902-555-5555 Date of Birth If you are 60 years or older on the day you apply, you will automatically be assessed for additional funding if required. Marital Status - Select -Married/Common-LawSingleWidowedDivorced/Separated Personal Health Number (PHN) Please enter the 8-digits from your PEI health card. Social Insurance Number (SIN) Is the civic address different than the mailing address entered above? - Select -YesNo Civic Address Address City, Town, or Community Province Postal Code Example: C1B 0X1 or 12345 Contact Permission Do you give permission for an official of the department to discuss this application and any information required to assess and complete the requested renovation with an identified contact? - Select -YesNo Provide details for the person the department official can contact to discuss your application. First Name Last Name Address Telephone Number For example 902-555-5555 Email Address Relationship to Applicant