Apply for Assistance - Tantramar Community Association

The information contained in this registration form is kept secure. It is not available to anyone outside the organizations partnering to provide you with assistance and is subject to federal privacy legislation. Information may be used for statistical purposes, but under no circumstances will any individual or family be identified. Under existing Canadian law, we are not permitted to share your information with any other Agency outside of this assistance process. If you have any questions in this matter, please contact the Tantramar Community Association.

Please note: Once your information has been reviewed, you will receive a phone call to discuss your request.

Personal Information

First Name * Required field.

Last Name * Required field.

Other Last/Family Name

Partner/Spouse Full Name

Address 1 * Required field.

Address 2

Town * Required field.

Postal Code * Required field. Please use the following format: XXX XXX

Phone * Required field. Please use the following format: ### ###-####

Email * Required field. Please enter a valid email address.

Average Monthly Income * Required field.

Average Monthly Expenses * Required field.

Previous Assistance

Month

Year Please enter your four-digit year of birth (e.g. 1995).

Assistance Type

Assistance Amount

Current Request

Type of Assistance You Are Seeking * Food
Heating
Medical
Rent
Sport Registration Fee
Other (please specify)
Required field. You must choose at least one.

Other Type of Assistance

Upload Latest Bill

Assistance is provided by means of direct payment to the service provider. Please upload a copy of your latest bill.

Disclaimer * I certify that the above facts are true to the best of my knowledge and belief. I understand that I may not be eligible to receive assistance if the above facts are found to be falsified.