COUCH Rental Application
All rentals are made without regard to race, color, religion, sex, age, ancestry, marital or familial status, physical or mental handicap, national origin, or sexual orientation. Feel free to answer "NA" or provide more information at the end of the survey about your answers. Answers are confidential within COUCH.  

We anticipate that filling out an application will take 30-60 minutes. You will have several opportunities to save your responses and quit for now, but submission of incomplete forms will not be considered for membership, so remember to come back and finish your application.
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Name (Preferred, Last) *
Pronouns *
Email *
Phone Number *
Current Address *
Which house(s) are you interested in applying to? *
Required
Our standard membership contracts run from August 15th to August 14th. What type of membership contract are you interested in signing? *
When would you ideally want to move to COUCH? Our most common move in date is at the start of the contract term - August 15th - but we can sometimes accommodate other move in dates depending on availability. *
Do you have any pets you will be bringing to the house? If yes, please list the type of animal, name, and size.

(a note)
All COUCH houses approve pets separately from each membership applicant, except for ESAs and SAs. Your membership acceptance will never depend on your pet(s). Our houses are generally pet friendly, and you should bring up the possibility of your pet moving into the house during your interview to get a better idea of logistics and any allergies among current house members. 
 *
When would you like to visit/Zoom for a membership dinner/interview, and which format would you prefer? *
Do you have any accessibility needs that you would like us to accommodate in the interview process? *
Will you be able to pay one month’s rent plus food/utilities the same day you move into the House? *
Will you be able to pay a security deposit (one month’s rent) the same day you sign a contract? *

Personal and Rental/Employment References (a note)

Personal references can be previous/current roommate, friend, academic advisor, coach, religious worker, volunteer leader, etc. We prefer to speak to someone you have lived with in the past. We prefer that you do not list a family member as a personal reference, except in cases where other personal references are not possible to obtain. We will be contacting these references and need responses to move forward with membership decisions, so please include people who are willing to be reached via email or phone, give them a heads up, and please especially provide an email when possible.
Personal Reference 1: Name, your relationship to them, their phone number, their email address. *
Personal Reference 2: Name, your relationship to them, their phone number, their email address. *
Rental or Employment Reference: Name of Individual, Company Name, Relationship, Phone Number, email address. *
How long have you known your rental or employment reference, and when were your dates of rental or employment? *
I understand and agree that my membership is automatically terminated for dealing drugs or becoming physically violent in Brooks, Harvest or Randolph House. *
I understand and agree to respect and support the following: *
Required
How did you find out about COUCH? *
Why would you like to live in a co-op? *
Have you had any other experiences living with large groups of people? If so, tell us about this experience. *
Tell us about a time when you had to communicate your wants or needs to someone else. How did you go about this? How did you get them to understand you? *
Ernie isn't the best at tidying up. He likes living in a co-op, and always says he completes his chores on time, but Bert is frustrated with the quality of Ernie's work. Bert, who always dedicates six full hours to chores, cooking and cleaning, and his permanent role in the house, is upset that Ernie seems to dedicate the minimum amount of time to cleaning.  Moreover, Ernie always leaves his personal items in common areas, and never puts his dishes in the dishwasher.  Ernie says this is the way his house was growing up. How would you address this situation?
Commitment to Diversity and Inclusion
COUCH has a commitment to inclusion and diversity. This means creating a living environment that is accepting and respectful of all aspects of a person's identity. Examples include (but are by no means limited to): personal background, socioeconomic status, educational status, age, race and ethnicity, religion or lack thereof, sexual orientation, gender expression, size, political affiliation, national origin, and language.
In your life, how have you demonstrated acceptance and respect of people's identities and experiences? Please be detailed in your response. *
How would you like to see people in this community supporting each other? What makes you feel supported in a community? How would you like your co-op to support and respect you as a person? *
Is there anything else you would like to tell us?
I hereby certify that information contained herein is true, complete, and correct. Otherwise, my membership is automatically disqualified. I authorize verification of above information from landlords, employers, and personal references I have listed and authorize the release of such by signature on this application. I acknowledge that false information contained herein will constitute grounds for termination of any lease arising from this application. (Sign Name and Date below) *
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