Submit a request

Please use the format A1A 1A1. Postal codes help StayWell identify potential funding opportunities for you.

Please enter the details of your request. A member of our support staff will respond as soon as possible.

I hereby authorize StayWell to collect and use the personal information provided in this request form, and any other personal information that I provide in connection with this request, to confirm my eligibility to receive services from StayWell and to provide me with services. I authorize StayWell to disclose my personal information to temporary housing providers for the purposes of confirming the availability of temporary housing that matches my needs and contacting me about such temporary housing. If I provide StayWell with personal information about another individual to use and disclose for these purposes, I acknowledge that I have their consent to do so.

I would like to receive email updates about StayWell’s services. I understand that I can withdraw my consent at any time.

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