Send to:
Mary Campbell Co-op
587 Talbot Street, London, Ontario, N6A 2T2
GENERAL INFORMATION
Date Application Received_______________
Applicant #1:
| Name: _______________________________________ | Birthdate: _______________________________________ |
| Address:_____________________________________ | Postal Code:____________________________________ |
| Home Telephone:______________________________ | Work Telephone:_________________________________ |
Applicant #2:
| Name:_______________________________________ | Birthdate:_______________________________________ |
| Address:_____________________________________ | Postal Code: ____________________________________ |
| Home Telephone: ______________________________ | Work Telephone: _________________________________ |
When would you be available for an interview? Days and time: _______________________________________________
Please list all other members of the household:
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Surname
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Given Names
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Birthdate
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Size of unit required?
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one bedroom |
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two bedroom |
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three bedroom |
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one bedroom designed for wheelchairs |
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two bedroom designed for wheelchairs |
When would you like to move in?________________________________________________
Do you have pets? __________________________________________________________
Do you require parking spaces?
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yes |
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no |
Do you require handicap parking spaces?
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yes |
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no |
How many spaces? ____________________
| Car license plate number(s): | _____________ |
| _____________ |
How did you hear about Mary Campbell Co-op? _____________________________________
Do you wish to be considered for Housing Charge Assistance if it is available?
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yes |
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no |
As a Co-op, we depend upon the help of all members in the running of the Co-op. This builds a greater sense of community and we are able to keep housing charge (rent) increases to a minimum. For this reason, skills, and experience in both personal and group activities are important resources for the Co-op.
Please see A Brief Description of Co-op Committees for more details of the kinds of ways in which members participate in our Co-op.
Applicant #1:
Participation is a mandatory condition of membership.
How many hours per month are you able to work at co-op duties? _________________________
Have you ever attended an Information Meeting?
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yes |
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no |
If yes, please give the date: ______________________________________________________
Applicant #2:
Participation is a mandatory condition of membership.
How many hours per month are you able to work at co-op duties? _________________________
Have you ever attended an Information Meeting?
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yes |
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no |
If yes, please give the date: ______________________________________________________
Who should we contact in case of an emergency?
Name: ______________________________________________________________________
| Address: | ____________________________________________________________________ |
| ____________________________________________________________________ |
Phone #: ____________________________________________________________________