Required fields are marked with asterisks (*)

Housing Stability Program Declaration and Consent Form

Are you a support staff member completing this form on behalf of a client?

Yes - I am staff from an organization completing the form on behalf of my client

Yes - I am staff from the Region of Durham completing the form on behalf of a client

No - I am completing the form for myself

If you require this information in an accessible format, please contact 1-800-372-1102 ext. 2805.