First Name: Last Name: Address: Telephone (home): (work): (message): Email Address: Birth Date (DD/MM/YY):
Co-Applicant/Spouse:
Children: 1. Name: Age: 2. Name: Age: 3. Name: Age: 4. Name: Age:
Other Adults who would occupy the unit: 1. First Name: Last Name: Age: 2. First Name: Last Name: Age: 3. First Name: Last Name: Age:
Pets: # of dogs: # of cats: other(specify):
Number of bedrooms you require:
Do you any of your household have health problems that affect your housing needs? If so, please specify:
Financial and Employment Information (if your employment is seasonal, please average to monthly figures)
Applicant:
Occupation: Present Employer: Employer's Address: Business Phone #: Income: Gross: Net: Additional Income: 1. Source: Amount: 2. Source: Amount:
Income of any other adults in the unit: 1. Name: Gross Income: Net Income: 2. Name: Gross Income: Net Income: 3. Name: Gross Income: Net Income:
May we use your employer as a reference? :
Are you receiving social assistance? : Monthly amount:
How much rent are you currently paying?:
In what type of accommodation are you living?:
Current landlord: Telephone #: May we use your current landlord as a reference? :
Previous Group/Community Experience
Have you ever lived in co-op housing, non-profit housing or any other subsidized housing? If so, please give details:
Have you ever participated in other kinds of co-ops, in a union, collective or group organization? If so, please describe:
Participation:
Our co-op requires an average of 8 - 10 hours per month participation from each member in some aspect of the co-op's management. Please indicate your areas of interest:
Do you have any special skills or interests which you could contribute to the running of the co-op? At the present time, we can only accept applications by mail. Please print out this form and mail it to: Vancouver East Housing Co-op Attention: Membership Committee 1220 Salsbury Ave. Vancouver, B.C. V5L 4B2
