Home Share - New Applicant - Building Bridges

Home Share Provider – New Applicant

Building Bridges only approves those with the skills, disposition, and physical accommodation to provide high-quality home share support to adults with diverse abilities.

Home Share Coordinators complete a rigorous and comprehensive assessment prior to approving any home share provider. Approval does not necessarily guarantee that a contract will be established with the potential provider. Contracts will be established when the individual, their family, or support network members decide whether or not a potential candidate meets the individual’s needs and preferences for support.

Home Share Providers contracted with Building Bridges only support one individual at any given time. Exceptions can be considered if the situation is compatible to the first individual in the home.

NOTE: This application form may take more than one sitting is complete. If you run out of time to complete the form, choose “Save for Later” at the bottom of the form before you submit it. Upon submission, you’ll receive an email with a link to complete the form.

What do you know about being a home share provider for an adult with diverse abilities?

Why are you considering becoming a home share provider at this time?

Will others be impacted by this decision (children, partner, others living in the home, etc.)? If so, have they been consulted and are they supportive of the choice?

How long are you able to commit to being a home share provider?

List those who currently live within the home. Provide details about their relationship to the primary applicant and their birthdates.

	Name	Relationship to primary applicant	Birth Date
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How did you meet your partner/spouse? How long have you been together?

Describe your own strengths, interests, and hobbies. How would these contribute to you being a good home share provider?

How are you and your family involved in your community (sporting/leisure activities, clubs/associations, volunteer work, etc.)? Describe the nature and level of your participation.

Are you affiliated with any specific religious/cultural organizations? Describe the nature and level of your participation.

Do you or any members of the household smoke? How do you feel about supporting someone who smokes?

Do you or any members of the household have chronic or communicable health conditions? If so, please describe.

Do you take regular holidays? How will becoming a home share provider impact this practice?

How would your decision to become a home share provider impact your overall lifestyle, regular schedule, commitments, and priorities?

Briefly outline your work history. Highlight any work experiences that are relevant to supporting individuals with diverse abilities.

Current Employer

Position

Length of Employment

Schedule

List the members of your household who are currently employed. Provide details about their employer, position, length, of employment, and work schedule.

	Name	Employer	Position	Length of Employment	Work Schedule
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Have you ever done home share, foster care, or respites support? If so, please provide details (agency name, dates, etc.)

Have you ever held a position or contract with Community Living BC, the Ministry of Children and Family Development, or a community living service provider? If so, please provide details (agency name, dates, etc.)

Are you currently supporting an individual with a diverse ability in your home? If so, please provide details.

What other agencies, if any, are you approaching to become a home share provider?

Have you been screened (partially or completely) by another service provider to become a home share provider? If so, please provide details.

Do you own or rent your home?

What kind of home do you have (condo, apartment, townhouse, detached home, etc.)? Briefly describe the home (square footage; one/two/three storey; number of bedrooms, bathrooms; layout/design features, etc.) and the exterior space

Does the home have any features that might limit or improve accessibility for someone with a physical disability or mobility challenges? Please describe.

Describe your vehicles (model, reliability, availability)

Are there pets in the home? If so, please provide details (type, breed, age, and disposition)

Describe your neighbourhood and provide details about proximity to services (schools, parks, community centers, shopping facilities, public transportation, leisure/recreation opportunities, etc.)

How long have you lived in this neighbourhood? Why did you choose to settle there?

Will you be sole home share provider supporting the individual, or will others in the home be sharing the responsibility?

Are there any other specific disabilities or challenges (not mentioned above) which you are not comfortable with?

If you become a home share provider, what support/training do you think you will need to be successful?

Anything further you would like us to know?

References - Primary Applicant

	Reference name	Home address	Phone number & email address	Place of employment	Relationship to candidates(s)
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References - Secondary Applicant

	Reference name	Home address	Phone number & email address	Place of employment	Relationship to candidates(s)
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Please read the following policy documents and check each box to acknowledge.

If there is a primary and secondary applicant, both must complete this section.

1	Name Signature Date
1	Name Signature Date

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Home Share – New Applicant

Home Share Provider – New Applicant

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