Personal Information

First Name *

Last Name *

Email *

Date of Birth *

Gender *
MaleFemale

Contact Number *

Education Information

Current Year *
---1stUpper YearGrad School

School to Attend *

Program *

Are you an exchange student *
NoYes

General

Did you know that you must complete three Ops Hours (required volunteer hours) per semester to maintain the general operations of the co-operative? *
YesNo

To maintain the meal plan did you know meal plan members are responsible for three hours of kitchen duties a week? *
YesNo

Application Information

I'm applying to: *
---Meal PlanNon-Meal PlanEither

Indicate your requested time of lease: *
---September - AprilSeptember - DecemberJanuary - AprilSummer

Are you applying with the intent of sharing a house or a room with someone specific? *
NoYes

If yes, what is their name? (They must also submit an application)

Reference

We accept references from Landlords, Dons or residence advisors, employers etc.

Please indicate your relation to this reference:

Reference Name

Reference Email

Relationship to Reference

Reference Number

If you were referred to KSHC by a Co-op member, please provide their name