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RENTAL REQUEST
1.
Name
2.
Email Address
3.
Telephone
4.
What is your Medical Profession. *Please note that we ONLY support Physicians, Nurse Practitioners, Resident Physicians, & Medical Students.
5.
What PNW community are you looking for accommodations in?
Dease Lake
Daajing Giids
Gitlaxt’aamiks
Houston
Kitimat
Masset
Prince Rupert
Smithers
Stewart
Terrace
Other (please specify)
6.
What community are you seeking accommodations in?
7.
What type of accommodation are you seeking? Click all that apply.
Entire house
Entire apartment
Established AirB&B, VRBO, etc.
Entire suite
Room in a shared space
Room & Board
Cabin
RV
Other (please specify)
8.
Do you require a furnished or unfurnished accommodation?
Furnished
Unfurnished
9.
What is your gender? (this information is required if you selected "Room & Board" or "Room in a shared space")
10.
Do you require a pet-friendly accommodation?
No
Yes (please specify)
11.
Are you the only person in your party?
Yes
No (please specify number of family members and how many bedrooms required)
12.
Do you require parking or will you be relying on public transit?
I require parking
I will be relying on public transit
13.
Rental amount (please provide your weekly/monthly rental budget amount with any relevant requests in regard to utilities, wifi, etc)
14.
Please provide estimated dates that you are seeking accommodation for. Include start and end dates.
15.
Do you have any special interests, hobbies, or activities that you would like more information about relevant to the community of your choice?
Current Progress,
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