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Miskanawah
Miskanawah
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KaPeKiwehtahat Pre-Screen - New Item
⚠
There are items in this form that require your attention
The
Ka-pe-kiwehtahat Housing Support Team
supports Indigenous people at risk of homelessness to assess existing housing challenges and risk factors, provide available resources, create a plan for housing security, and build strategies to prevent homelessness in the future.
Individual
Full Name
*
Date of Birth
*
Phone Number
*
Email
*
How did you hear about the Ka-pe-kiwehtahat Housing Program?
*
Are you connected with any other programs at Miskanawah?
*
None
Strengthening Home Fires
Nitsanak Mamawintowak
Tawaw Family Resource Network
Miywasin Nohkom
Diamond Willow Youth Lodge
Healing Lodge
Other (describe below)
Other Miskanawah Program
Do you identify as Indigenous?
*
Yes
No
Do you live in Calgary and surrounding area?
*
Yes
No
Have you received financial support from Miskanawah's housing program in the past 12 months?
*
Yes
No
Are you currently living in shelter?
*
Yes
No
Do you have a lease in your name?
*
Yes
No
Our supports require a current signed Lease: Which option best describes your current status:
*
I currently have a signed lease
I am working on obtaining a new lease
No lease, but I have an approved rental application form
My current lease is expired, I'm on a month-to-month lease
What expense are you seeking financial support for?
*
Amount of support needed
*
When is this support needed by
*
What is your total monthly income?
*
What is your source of income? (select all that apply)
*
Employment
Self-Employed
Alberta Works
AISH
Student Funding
EI (Medical/Unemployment pay)
Unemployed (No income)
Child Tax Credit
Child Support
CPP/Pension
Other (specify below)
Source of income - Other
Miskanawah is rooted in cultural ceremonies and practices and prides itself in sharing Indigenous ways of knowing, being and doing with the greater community.
Guided by the concept of Wahkotiwin (Cree for ‘living in relationship’), we strive to build a strong and resilient community of care by inviting our circle of relatives to join us in Indigenous traditions, ceremony and celebration (eg. sharing circles, sweat lodges, pipe ceremonies, connecting with Elders, medicine picking, drum makin
g, etc.)
.
Are you interested in receiving information from our Cultural Team about ongoing cultural opportunities and connections, regardless of whether you qualify for financial support at this time?
*
Yes
No
By signing this form, I consent to have Miskanawah staff collect my personal information for the purpose of assessing my eligibility for housing supports.
Type Your Initials Here to Acknowledge Consent
Follow Up
Individual Contacted
Date Contacted
Contacted By
None
Amber Wold
Amie Prince
Angela Brooks
Anna Campbell
Beverly Delion
Bree Forest
Candice Klebe
Caroline Tom
Carolyn Gordon
Cathy Kostincer
Chantel Large
Chris Wainwright
Daphne You
Dayne Williams
Dolly Parton (Sample Staff User)
Eileen Grady (Sample Staff User)
Erin Henderson
Gail Staffa
George Wentworth (Sample Staff User)
Jacqueline OSoup
jacqueline.shaw
Jennifer Fox
Jennifer Fraser
Kim Radek
Kirby Redwood
Kristina Cancillar
Krystle Dawn
Linda Collins
Louise Dempsey
Lynette Persaud
Mariah Mackay
Max Moore
Melissa Bohnsack
Mutriba Din
Natasha Goodman
Natasha Houghton
Nouran Belassi
Orleane Twin
Paige Cairns
Paul Forcet (Sample Staff User)
Sheila Sharma
Shylo Cayer
Stanley Vifemsi
Tamara Mitchell
Tara Dame
Tara Fillo
Tendai Makwanha-Bere
Tester User
Test User (Sample Staff User)
Tim Konditi
Tracey Berezuk
Tracey Gilbert
Tricia March
Tristen Bremner
Virginia Sharlow
Wendy Li
Wes Crazy Bull
Notes
Outcome of Pre Screen
Eligible for Program Support - Proceed with Intake
Eligible for Program Support - INTAKE COMPLETED
Not Eligible for Program Support - Refer to Resources
Reason for not providing support at this time
None
Currently in shelter
Does not have a lease
Income insufficient to sustain housing
Resides outside of Calgary
Does not identify as Indigenous
Previously received support from the program
Other (specify below)
If other, please explain
External resources provided
Trellis Diversion Program
Inn from the Cold
Little Moccasins
The Drop-in Centre
Jordan’s Principle
Indigenous Bands
Alberta Works
CUPS
The SORCe
Other (specify below)
External resources - Other
(if you selected Other, please describe)
Internal (Miskanawah) referrals made
TAWAW Care Connector (FRN)
Diamond Willow Youth Lodge
Healing Lodge
ReVision
Planet Youth
Other (specify below)
Internal referrals - Other
(if you selected Other, please describe)
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