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Personal Information

First name *

Last Name *

Email *

Date of Birth *

Gender * Female Male

Current Address

Current Address *

Current Postal Code *

Current Phone Number *

Current Cell Number *

Permanent Address

Pernanent Address *

Permanent Postal Code *

Permanent Phone Number *

Educational Information

Current Year

School to Attend

Program

Are you an exchange student? Yes No

General

In your own words, please explain how a housing co-operative works (check out www.science44co-op.com for more information). *

List 3 things you could do to lower your ecological footprint in housing *

What activities / clubs / organizations are you currently involved with? *

What do you think you can contribute to the Co-Op community? *

Did you know that you must complete three Ops Hours (required volunteer hours) per semester to maintain the general operations of the co-operative? Do you agree to do these hours? * I agree I disagree

To maintain the meal plan, did you know that meal plan members are responsible for a three hours of kitchen duties every week? Do you agree to do these hours? * I Agree I disagree

Application Information

I am applying to *

Are you interested in summer? Yes No

What length of time are you looking to lease your room for?

How did you hear about Co-Op? *

Are you applying with the intent of sharing a room with someone? * Yes No

If sharing room what is their name*. (*they must also submit an application)

Is there any other information you would like to share with us?

Reference

Previous landlord? Yes No

Name

Address

Phone Number

Co-op member reference name

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