Contact Information
Name of Household Contact Person (This person will be the single point of contact for the household):
Maximum 255 characters
0/255
Contact Email:
Contact Phone:
Alternate Phone:
Personal Details
Age:
Please indicate if you have any pets (please indicate size, type and any other important info).
Please indicate your job status.
We want to know if you work in a service area that is essential for our community to function on a basic level. Do you or someone in your household fit into one of these categories?
Who is your employer?
If you work for Parks Canada or the Municipality of Jasper, please state which department you work for.
If you have a job, are you currently working remotely or not able to work remotely?
Housing Details
Please share your previous physical address in Jasper (not a PO Box number).
Did you live in a single bedroom in a shared house?
Please list additional members of your household (not including you). Please state the number of adults and children and include their ages.
Please indicate if you lived in staff accommodation.
What kind of insurance coverage do you have?
Please tell us how many vehicles you have.
Housing Needs
When do you need to access temporary housing? Please select date.
How long will you need housing for?
Does your household need any accommodations for diverse physical or cognitive abilities? For example, wheelchair accessibility, mental health considerations, medical equipment, etc.
Please tell us about any large or special items you want us to know about that may impact where you are able to live. For example, a larger medical unit/device, a playpen, a wheelchair, etc.
Please give us an idea of you or your household’s financial situation.
