| Fields marked with * are required. |
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E-mail address*:
(This will be your username
to log in to the system later.) |
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| Please choose a password*: |
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| Re-enter password*: |
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First/Given Name*:
(Legal name) |
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Last/Family Name*:
(Legal name) |
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| Nickname: |
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| Gender*: |
Male
Female
Self-identify:
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Would you prefer to room with*:
(Note: if we assign you a roommate, this will affect who we choose.) |
Male
Female
Doesn't matter |
| Date of Birth*: |
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| Current Address*: |
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| Phone*: |
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Permanent Forwarding Address*:
(Parent, guardian or relative) |
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Permanent Phone:
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| Student status during contract period (or, if spring/summer, for the following fall)*: |
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| If student, from what school? |
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Other School:
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Are you a returning member?
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Y
N |
| If so, what year did you last live in the ICC: |
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| And in what house: |
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| Do you have any medical needs that your housemates should
be aware of? |
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| Do you plan to bring a pet with you to the co-ops? |
Y
N |
| If so, what type? |
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Were you recruited by a current ICC member?
If so, fill in their name and house:
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Recruiting Member's Name:
Recruiting Member's House:
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Are you replacing a current ICC member?
If so, fill in their name and house:
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Replaced Member's Name:
Replaced Member's House:
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| Food Preferences: |
Other:
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| Smoker: |
Y
N
Occasionally |
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| How did you hear about
the ICC (check all that apply): |
Friends
Family
Flier
UM Off-Campus Housing Office
UM Off-Campus Housing Website
Google Ad
Craigslist
Diag Board
Newspaper/Magazine
T-Shirt
Professor/Teacher/Advisor
Bus Sign
Event
Web Search
Facebook
Other:
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Please enter any additional comments
in the text area below. |
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THE FOLLOWING QUESTIONS
ARE OPTIONAL:
These questions will help us understand the depth and breadth of diversity within the ICC. Though this section is optional, we would appreciate your contribution to better know our community. Thank you! |
| Area of Study: |
Other:
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| Level in School: |
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| Are you an International Student: |
Y
N |
| If so, from what country: |
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| Ethnicity (check all that apply): |
Caucasian/White
Black/African American
Asian/Pacific Islander
Hispanic/Latino/-a
American Indian/Alaska Native
Middle Eastern
Other:
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| With what faith do you identify? |
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| What is your native language? |
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| What is your sexual and/or affectional preference? |
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| Please indicate the highest level of education achieved by your parent(s) or guardian(s): |
Mother:
Father:
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| Are you dependent on your parents to pay for school tuition and/or housing? |
Y
N |
| If yes, please indicate the approximate combined parental income: |
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| If no, please indicate your personal income: |
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| Do you receive financial aid: |
Y
N |
| If so, what type (check all that apply): |
Grant
Loan
Scholarship
Work Study
Other:
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| Do you plan to work while living in the ICC: |
Y
N |
| If so, how much: |
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PLEASE SEND US ANY ADDRESS CHANGES THAT OCCUR
AFTER YOU APPLY
Replies are sent out on the basis of the date
received and preferences indicated.
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