First Name *
Last Name *
Email *
Date of Birth *
Application Number
Self-Identify * —Please choose an option—MaleFemaleOther
Contact Phone Number *
Home University/ College/ Institution
Current Year of Study —Please choose an option—1st YearUpper YearGrad SchoolNot Applicable
School to Attend for Duration of stay *
Study Program *
Will you be Domestic/ International- Exchange student? —Please choose an option—Domestic UndergradDomestic GradInternational UndergradInternational GradNot Applicable
I'm applying to: * —Please choose an option—Meal PlanNon-Meal PlanEither
Indicate your requested time of lease: * —Please choose an option—September - AprilSeptember - DecemberJanuary - AprilPartial SummerFull Summer
Please specify dates * From To
If you have an intent of sharing a house or a room with someone, Please specify name? (They must also submit an application)
Please select a desired Room size —Please choose an option—XL/ JumboLargeMediumRegularSmallExtra SmallAny
Which type of house you prefer —Please choose an option—Party houseQuiet houseDoesn't Matter
Did you know that you must complete three Ops Hours (required volunteer hours) per semester to maintain the general operations of the co-operative? By selecting Yes, you agree to this commitment* YesNo
To maintain the meal plan did you know meal plan members are responsible for three hours of kitchen duties a week? By selecting Yes, you agree to this commitment* YesNo
We accept references from Existing or previous Coop members, Landlords, employers etc.
Reference Name
Reference Email *
Relationship to Reference *
Reference Number
If you were referred to KSHC by a Co-op member, please provide their name
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