ApplicationOnce approved, a deposit of $1000.00 must be paid to hold the desired suite Where did you hear about this residence? Dugaldplace.com Highway #15 Signage The Clipper Weekly The Winnipeg Free Press Kijiji Facebook Instagram Google RM of Springfield Website Springfield Chamber of Commerce Website Word of Mouth Other Occupancy Date requested MM DD YYYY Designation * Mr. Mrs. Ms. Mr. & Mrs. None Applicant Name * First Name Last Name Applicant Birthdate MM DD YYYY Co-applicant Name Co-applicant Birthdate MM DD YYYY Questions about age and health are not mandatory Present Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone * (###) ### #### Cell Phone (###) ### #### Email * Contact Person (next of kin) Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone/Cell (###) ### #### Relationship Accommodation Suite Type Being Applied For * Two Bedroom One Bedroom Still Unsure Parking Stall(s) Required * None One Two Special Requests Health Questions about age and health are not mandatory. Are you able to live independently? Do you have any disabilities? Will you require Home Care from the Regional Health Authority? Please have someone call me with more information * Yes No Please have someone call to set up a tour of Dugald Estates and see plans for Dugald Place * Yes No When an application is submitted for the waiting list, a $1000 deposit is required, which will be applied towards rent. The date application and deposit are received by the office forms the basis of the waiting list and the order in which suites are filled. The first time a suite is offered to a prospective tenant and declined, the prospective tenant remains in their current position on the waiting list. The initial $1000 deposit is refunded if an applicant requests their name be removed from the waiting list. Make cheque payable to: Springfield Heritage Housing Inc. Mail to: Dugald Place, 1000-800 Jaffray Street, Dugald, Manitoba. R5P 0E9 Cheque will be held in trust for Dugald Place Assisted Living Residence, a project of Springfield Heritage Housing Inc. Thank you!
