Housing Questionairre

Co-op/Intern Housing Form

Name

     

Marital Status

     

Residential Address:

Business Address

Street Address:

     

Street Address:

     

City:

     

City:

     

State:

  

Zip Code:

     

State:

  

Zip Code:

     

Contact Information

Employer:

     

Work Phone:

(   )

   

-

    

Job Title:

     

Cell Phone:

(   )

   

-

    

Reference:

     

Phone Number:

(   )

   

-

    

Renting Address

     

City

     

Zip Code

     

Time to JSC

     

Miles to JSC

     

Number of spaces to rent

  

Number of permanent residents

  

Number of children

  

Gender Preference

Rent per room

     

Deposit:

$     

Pets

Description of pets

     

Pets Allowed?

Overnight guest allowed?

Smoking in house?

Parking (driveway, garage, or street):

Utilities Included?

Phone Included?

Internet Included

Kitchen Privileges

     

Kitchen information

     

Laundry Privileges

     

Laundry Information

     

Furnished?

If yes, description

     

Bedroom Shared?

Bedroom Description:

     

Past Co-ops who have lived here

           

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