Demonstration only. The Province of Westmark is fictional. Nothing you enter here is stored or submitted.
WestmarkCommunity & Social Services
Home Benefits & financial support Family Support application

About you

Tell us who is applying.

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Applicant's legal first name
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Applicant's legal last name
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Applicant's date of birth
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e.g. 555-201-4477
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Applicant's email address

Address

Where you live now.

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House number, street and unit, e.g. 214 Birch Lane, Unit 3
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City or town of residence
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Six characters, e.g. A1B 2C3

Household

Who lives with you and your housing costs.

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Applicant's current marital status
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Children or relatives who depend on you, 0 if none
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Applicant's current housing arrangement
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Whole dollars per month, 0 if none

Income

Your household's income before deductions.

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Applicant's current employment status
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Whole dollars per month, before deductions, all earners combined

Support program

Choose the program you're applying for.

Support program

Your situation

A few sentences in your own words.

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Short description of the applicant's circumstances and why support is needed

Contact preferences

How a caseworker should reach you.

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How the applicant prefers to be contacted
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Language for letters and calls

Declaration

Please read and confirm. Only you can tick these boxes.

Eligibility is decided by a caseworker after your application is reviewed. Ava can help you fill the form but can't tell you whether you qualify.

Demo only: nothing is saved or sent.

Application received

Thank you, resident. Your application is in the queue for review.

Reference WM-000000

Demonstration: the reference number is generated in your browser and nothing was submitted.