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MSU SHC Member Check Out Form
541 Grand River Ave ~ Michigan State University ~ East Lansing, MI 48823

Phone: (517) 355-8313 ~ Email: coop@msu.edu

You are responsible for completing this checklist before leaving the MSU SHC. This form is to be completed
by you and then verified by Membership Officer of your house. Your Membership Officer will then be responsible for documenting the status of the room. If this form is turned into the MSU SHC Office but the required cleaning was not completed, you will face a $25 forfeiture of your Member Shares for the time spent by other members making the space habitable again. Please leave your space cleaner than you found it so that you can ensure that the next co-oper moving in can come into their new home with ease.

Please choose most applicable answer: *
Items in Rooms
Please check boxes for all items currently in rooms. If an item is damaged please write in notes portion below.
Windows & Walls
Your answer
Light Fixtures
Notes:
Your answer
Smoke Detector
Notes:
Your answer
Furniture
Notes:
Your answer
Door
Notes:
Your answer
Room Condition Check List
For Bathrooms if Attached to Room
Member Verification
By typing your name below you are verifying that you answered this document in truthful manor. You are also accepting responsibility for any damage that may have occurred during your occupancy in said room and the charges that would be needed to fix said damage.
Name:
Your answer
House
Your answer
Room Number
Your answer
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