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Approval Form

Certain types of contracts require house approval before the office can issue you a contract. Please complete all applicable fields below and press submit at the bottom of the page. The house will use this information to decide on your approval.

Fields marked with * are required.
E-mail address*:
First/Given Name*:
(Legal name)
Last/Family Name*:
(Legal name)
Student status during contract period (or, if spring/summer, for the following fall)*:
House*:
Contract period(s)*: Fall/Winter 2011-12
Spring/Summer 2012
Fall/Winter 2012-13

Type of Approval Needed*:
(select all that apply)

 Non-Student
Fall Only Contract
Non-Standard Contract
Non-Graduate Student
Partial Board
Pet Approval
Buy out of one term
Buy out of two terms
Sign a contract on referral
Hold a space on referral
Hold a space with high balance
Non-Standard
Contract Dates:
 Start date:
End date: 
Pet type*:
Other pet:
Pet's name:
Pet's age:
Pet's weight (approx.):
Comments about pet:
Current Address*:
Phone*:
Present living situation*: Co-op
Rental
University Housing
Family
Other (specify):
Name of current Landlord/RA/House president/etc*:
Their phone number*:
May we call this person for a reference?
 Y N
Why do you want to move into (or stay in) the co-ops?
If you are a NON-STUDENT you must complete the following three sections (previous addresses, financial support, employment):
Previous Addresses:
Previous Address #1:
Period of Residence:
Name of previous Landlord/RA/House president/etc:
Their phone number:
May we call this person for a reference?
 Y N
Previous Address #2:
Period of Residence:
Name of previous Landlord/RA/House president/etc:
Their phone number:
May we call this person for a reference?
 Y   N
Financial Support :
Please indicate your source(s) of financial support for the period of your intended contract (check all that apply):

Family
Employment
Other (specify):

Employment :
Present Employment:
Your Position or Title:

Company Name:

Hours/week:

Rate of pay:


per hour   annually
Dates of Employment:
Supervisor's Name:
Their phone number:
May we call this person for a reference?
 Y   N
 
Second Job or Previous Employment:
Your Position or Title:

Company Name:

Hours/week:

Rate of pay:


per hour   annually
Dates of Employment:
Supervisor's Name:
Their phone number:
May we call this person for a reference?
 Y   N
By submitting this form, I hereby authorize and permit the Inter-Cooperative Council to perform a background check to obtain information about me from law enforcement and/or credit agencies, courthouses, personal, professional and residential referenfences and employers. I also authorize and give permission for all such parties to disclose any information requested about me to the Inter-Cooperative Council.
If you are a non-grad student wishing to move into the Graduate Co-op, please answer the following additional questions:
Why do you want to move into the Graduate Co-op?
How does your personality fit into the environment of a graduate house?
What type of living environment are you looking for?
Have you ever lived in a cooperative environment before? If so, where?
Please write any other information you feel is important:
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contact
ICC Office: 337 E. William St., Ann Arbor, MI 48104 | (734) 662-4414 |
fax (734) 662-5870 | info@icc.coop | Copyright 2003, icc.coop
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