Grand Rapids Alliance of Cooperative Communities Housing Application
Email address *
Legal Name *
Your answer
Name you go by/nickname (if different from above)
Your answer
Phone Number *
Your answer
Birth Date *
MM
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DD
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YYYY
Current address and dates of residency *
Your answer
Last address and dates of residency *
Your answer
Would you like to bring any pets? *
Name of Pet
Your answer
Species of Pet
Your answer
Dietary Preferences
Any Food or Pet Allergies?
Your answer
When would you ideally like to move in? How flexible is this? *
Your answer
Would you plan on ongoing residency (over 12 months) or do you have a specific end-date in mind? *
Your answer
Income and source of income: *
Your answer
Have you ever been asked to leave a residence? *
If so, explain
Your answer
Emergency Contact Name *
Your answer
Relationship to Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Current Employer *
Your answer
Current Position *
Your answer
Date of Hire (1) *
MM
/
DD
/
YYYY
Housing Reference (current or previous landlord) *
Your answer
Relationship to Reference *
Your answer
Housing Reference phone number *
Your answer
Consent to Credit Check? *
Required
SSN# *
Your answer
Thanks for your interest in our little experiment! Anything else you'd like to add about yourself?
Your answer
By completing this survey you are consenting to a criminal and rental history background check *
Required
A copy of your responses will be emailed to the address you provided.
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