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Fletcher Collective Membership Application
Name
*
Date of Birth
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
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Year
Year
1923
1924
1925
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1927
1928
1929
1930
1931
1932
1933
1934
1935
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1988
1989
1990
1991
1992
1993
1994
1995
Phone Number
*
Email
*
Gender Identity
Current Address
*
City
*
State
*
What is your rooming preference?
*
Single
Double
Doesn't Matter
Would you prefer to room with a
*
Male
Female
Doesn't Matter
When do you plan to move in?
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2013
2014
2015
2016
Have you ever been convicted of a gross misdemeanor or felony?
*
Yes
No
If yes, please specify
Do you plan on bringing any pets?
*
Yes
No
If so, what kind/s?
Do you plan on bringing a car?
*
Yes
No
Do you plan on bringing a bike?
*
Yes
No
Are you a smoker?
*
Yes
No
What is your food preference?
*
Omnivorous
Vegetarian
Vegan
Other
Medical needs that your housemates should be aware of
How do you plan on paying your monthly dues? (check all that apply)
*
Savings, loans, financial aid, or other
Income from employment
Parent, legal guardians, or other
Have you ever lived in a cooperative before?
*
Yes
No
If yes, When?
If yes, Where?
Have you ever rented before?
*
Yes
No
Landlord Name
Landlord Address
Landlord Telephone
Landlord Name
Landlord Address
Landlord Telephone
How much do you earn annually?
*
Less than $22,000
Between $22,000 and $35,200
More than $35,200
Income for the most recently completed calendar year, including total wages, salaries, tips, bonuses, commissions, self-employment income, interest, dividends, investments, scholarships, grants, regular support from parents or family, and other income sources. Every year, KCH must certify that the KCH resident membership is composed of at least 75% low-income people and 20% very low-income people (according to the US. Department of Housing and Urban Development). According to this department, low-income individuals receive no more than 80% of Kalamazoo’s median income and very low-income individuals receive no more than 50% of Kalamazoo’s median income
How did you hear about KCH?:
Please describe yourself (studies, jobs, organizations, hobbies, interests, goals, background, etc)
Why are you interested in living in a cooperative?
