Pheasant Meadows Housing Cooperative

As per the PERSONAL INFORMATION PROTECTION ACT (PIPA), applications are retained for 6 months and then destroyed.

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*Applicant First Name

*Applicant Last Name

*Phone

Alternate Phone

*Email

*Address 1

Address 2

*City

*Province

AB BC MB NB NL NS NT NU ON PE QC SK YT Other/International

*Postal Code

0/7

*Date of Birth

*Applicant - Name of employer or source of income (e.g. social assistance, CPP, OAS)

*Applicant - How many years with current employer?

Less than 1 year     1-2 Years     2-5 Years     5-10 Years     10+ Years    

*Applicant Gross MONTHLY income each MONTH.

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Email

Co-Applicant Phone

Co-Applicant Alternate Phone

Co-Applicant Address 1

Co-Applicant Address 2

Co-Applicant City

Co-Applicant Province

AB BC MB NB NL NS NT NU ON PE QC SK YT Other/International

Co-Applicant Postal Code

0/7

Co-Applicant Date of Birth

Co-Applicant - Name of employer or source of income (e.g. social assistance, CPP, OAS)

Co-Applicant - How many years with current employer?

Less than 1 year     1-2 Years     2-5 Years     5-10 Years     10+ Years    

Co-Applicant Gross MONTHLY income

All Others Gross MONTHLY Income

Other Household Member 1 Name

Relationship to Applicant

Date of Birth

Sex

Male     Female    

Other Household Member 2 Name

Relationship to Applicant

Date of Birth

Sex

Male     Female    

*Do you expect the size of your family to change?

Yes     No    

If Yes, please explain

*How many people live in your current residence?

1     2     3     4     5 or more    

Please explain if this is different from the number of people who you expect to be living in your unit in the Co-op, should you be accepted.

*How long have you lived at your current address?

Less than 1 year 1-2 years 2-5 years 5-10 years 10+ years

If you lived there less than 2 years, please give your previous address and how long you lived at this address.

*Present Accommodation

Own     Rent     Hotel/Motel     Shared Accomodation     Transition House     Other    

Pheasant Meadows Housing Cooperative requires as much specific information on your present housing as you can provide. Most of the following section can be answered by making a selection. Feel free to fill in the additional comments section with any additional information that may assist us in determining your requirements.

*How much rent do you pay per month?

*Landlord’s name

*Landlord's Phone Number

*Do you have a pet?

Yes     No    

The Co-op has a pet policy that allows 2 spayed/neutered pets. No aggressive breeds. Exotic pets need to be approved by the Board.

If Yes, what type and dog breed (if applicable)?

*Smoking of any kind (tobacco, cannabis) is prohibited anywhere on the property and can result in termination of membership. Are all the members of your household able to comply with this occupancy guideline?

Yes     No    

*Have you ever interviewed at Pheasant Meadows before?

Yes     No    

If yes, when was the date of your interview?

*Have you ever lived in a housing cooperative?

Yes     No    

If yes, please specify the name of the Co-op

Co-op Member Reference Name

Co-op Member Reference Phone

*Member participation is required and is a condition for being accepted at our Co-op. Members are required to contribute a minimum of 2 hours per month. If approved for membership, will you fulfill this commitment?

Yes     No    

*On which of the following committees will you participate if you are a selected member?

Board of Directors     Maintenance     Membership     Social    

*Do all applicants and occupants regularly reside together at least 50% of the time?

Yes     No    

If not, please explain.

Additional Comments

*Acknowledgement and acceptance of Membership Requirements

I Acknowledge and accept the Rules and Income Verification requirements as set out by Pheasant Meadows Cooperative in this application.    

We understand that only the members of Pheasant Meadows Co-operative Housing may live in the co-op and we apply for membership, as set out below. We understand that, if the co-op accepts us for membership and offers us a unit, we must buy a share purchase of $3,500 for the principal member and $10 for each associate member. If accepted into membership, we agree to be bound by and comply with the Rules and Occupancy Agreement and Policies of the Co-op in force and as amended from time to time. We declare that all the information provided in this application is correct. We give the Co-op permission to verify any or all of this information, and to perform a landlord check and credit check. We understand that acceptance for membership also depends on the Co-op obtaining satisfactory results from a credit check.

*Are you human? If so, what is two plus 69?

Fields with (*) are compulsory.