UNIVERSITY COOPERATIVE HOUSING ASSOCIATION (UCHA CO-OP)
APPLICATION FORM
Website: www.uchaonline.com
Fax # 310 824 0112
The UCHA co-op is a non-profit organization that offers low cost housing to students from UCLA and other colleges. What is unique about the co-op is that most of its day-to-day chores and activities are conducted by the student members (i.e. residents) themselves that live here. Members are responsible for the efficiency of the organization, which includes part-taking in decision making, problem solving and general operational activities. As such, we depend on the cooperative contribution and conduct of members and welcome those that appreciate this principle, and are willing to contribute towards its successful operation. This application must be forwarded with a $35.00 (U.S.) application fee (non-refundable). Payment of the $1,000.00 (refundable) deposit will only be accepted at check-in. Payment of the deposit is not a requirement for approval and is not a guarantee of admission. A decision regarding your application will be made thereafter (approx. time: 2-4 weeks). Applicants may not at anytime assume that admission has been granted until in receipt of official confirmation from UCHA in writing. On receipt of an offer of admission a space may be reserved thereafter, by payment of the $500.00 (non-refundable) reservation fee, which will be credited towards the 1st room & board payment (Applicants are requested not to send the $500.00 until invited to do so by UCHA). All other payments i.e. $150.00 membership fee (non-refundable) and any pro-rated room/board (see the reverse for details), will be receipted only after a space is offered, and the offer of admission is accepted. Housing is per quarter, and residents are responsible for the entire quarterÕs room and board (i.e. Rent) fees regardless of the actual days spent at UCHA in a quarter, but pay in monthly installments due on the first day (of each month). At the Co-op, members compete for their choice of rooms based on seniority. As such, new members should expect to be in a Triple room (at least the first quarter of their residence at UCHA) until sufficient seniority is earned. All payments must be made by: Cash, Visa, Master card, Money order or TravelerÕs checks (Please make all Money orders or TravelerÕs checks payable to ŌUCHA.Ķ).
We do not accept American
Express, the Discover card, or personal checks.
EXPRESS FEE: Applicants wishing to have an early response to their applications may request so by payment of a $20.00 (non-refundable) express fee along with the $35.00 application fee. (UCHA reserves the right to decline an Express fee request and such requests, will only be accepted from applicants moving in within four months of the date of submission of the application). On receipt of this request, UCHA will post or E-mail a response on the status of an application within 3 business days.
We welcome and encourage you to visit the
co-op and take part in an official tour. For tour times call-310 208 8242
Thank you and we look forward to having you stay with us here at the UCHA co-op.
Quarter applying
for (Circle one): Fall_________, Winter_________, Spring________,
Summer__________.
(The UCHA Co-op quarter and all
check-in/out dates are based around the UCLA undergraduate calendar –
Students applying to UCHA and attending schools with different start/end dates
should be and are assumed to be prepared to observe this schedule).
Mr._______ Ms._______, Family (Last) Name_________________________ First
Name________________
Date of
Birth____________ Country/State of Birth__________________ Citizenship___________________
Mailing Address:
____________________________________________________________________________
Street
City
State/Zip code
Contact phone:
Home_____________ Work_______________ E- Mail _____________________ Fax
_______________
Social
Security/Passport #_______________ Country_______ DriverÕs License
#______________ State/Country_______
When would you
like to move in? Date_____ Month
___ Year ____. Are you a Full-Time student? Yes_____ No ____, College
you will attend while at the Co-op? UCLA ____ UCLA Staff____ EAP ____Extension
____ ALC _____SMC___ Other _________. Undergraduate _______Graduate _______
Other (specify) _____ (PLEASE
NOTE, YOU NEED TO BE A FULL-TIME STUDENT THE QUARTER OF RESIDENCE AT THE UCHA
CO-OP.).
PARENTÕS NAME:
MOTHER_________________________ FATHER____________________________
ADDRESS:
______________________________________________________________________________
Street
City
State/Zip code
CONTACT PHONE:
Home_______________________ Work________________________
_________________________________________________________________________________________________
Contractual Obligations: All members are required to perform a
chore obligation of four/five hours per week. Also, members are required to
perform an additional four hours per quarter in fulfillment of their Quarter
Project Hours (QPH).
References: Please list the names of two previous
landlords in whose apartments you have lived within the last 3 years.
Name
Phone
Month/Year
till Month/year
1_____________________________________________________________________________
(Do not list relatives)
2_____________________________________________________________________________
(Do not list relatives)
Name(s) _______________________________Relationship: _______________________________________________
Address: _________________________________________________________________________________________
Street City State/Country Zip code
Phone: Home_________________________ Work______________________________
I hereby authorize UCHA to contact the person/s mentioned above in the event of an emergency, and disclose any information as deemed necessary by UCHA.
Signature:
__________________________________ Date: ____________________
How did you learn
about UCHA? Bruin Ad _____, mailing _____, campus posting _____, friend
______, other______,
Have you ever been
convicted of a felony or misdemeanor? Yes__ No __If yes, please give details:
Have you lived
here before? Yes__ No __ If yes, when? From______ till ________ Were you
expelled/Evicted? ________
Have you applied
to UCHA before (for housing)? Yes ____ No _____ If yes, when? _________________
Have you been evicted by a previous landlord? Yes___ No___ If yes, Explain:
__________________________________
I certify, with my signature below, that I understand all of the policies and conditions stated in this application, and that the information I have given (in this application) is correct and truthful. My signature also authorizes UCHA to verify my student status, credit history, and any or all information listed, and I am aware that I/or my family members will be contacted regarding and to recover any debts I may incur while at UCHA. I also understand that failure to disclose the truth will be grounds for immediate withdrawal of admission, and termination of my contract, and understand that the UCHA also reserves the right to make any changes, withdraw any offer of admission, or cancel reservation, and for no cause.
Signature:
________________________________ Date: _____________
Parent/Guardian signature if applicant is under 18___________________________ Date____________
I authorize UCHA to debit my credit card #__________________for a total of US $ ______ Expiration ____Security code: _____
(last three digits), Zip code _____________, Street # ________________.
Signature:
__________________________________________ Date: ________________
NOTICE: ALL CHECK-INS MUST BE DONE IN
PERSON AND MAY ONLY BE DURING OFFICIAL OFFICE HOURS (I.E. MON.-FRI. 12 PM-8
PM). HOURS VARY DURING THE HOLIDAY
SEASONS. PLEASE CALL 310 208 8242 OR EMAIL AT UCHAWEB@EARTHLINK.NET
TO CONFIRM TIMES.
Also, please bring two forms of photo ID, one from the college you will be attending in Los Angeles. (An admission letter will also be adequate). Please note: This application is valid for only one Academic year (Fall through summer. If admission is not gained during this period, a new updated application will need to be filed.
_________________________________________________________________________________________________
AT CHECK-IN,
ROOM/BOARD (R&B) PAYMENTS WILL NEED TO BE MADE AS FOLLOWS:
- For Check-ins
during the 1st month of the UCHA quarter: R&B due-$500.00 (i.e. reservation fee).
- For Check-ins
during the 2nd month of the UCHA quarter: R&B due will be for the remainder
of the quarter on a pro-rated basis (with a minimum due of $500.00). The $500.00 reservation fee will count
towards the Pro-rated R&B.
- For Check-ins
during the 3rd month of the quarter: R&B due will be the Pro-rate for the
remainder of the quarter, and the $500.00 (Reservation fee), which will be
applied towards the R & B requirement for the next quarter.
ADDITIONALLY:
ANY CHECK-INS (WITHIN TWO WEEKS) PRIOR TO THE OFFICIAL CHECK –IN DATE,
WILL BE BILLED @ $25.00 A DAY, UNTIL THE OFFICIAL UCHA CHECK-IN
DATE. ANY CHECK-INS AFTER ZERO
WEEK AND THE FIRST WEEK OF THE (UCLA UNDERGRADUATE) QUARTER, WILL BE BILLED ON
A WEEKLY PRO-RATED BASIS. _______________________________________________________________________________________________
FOR OFFICE USE
ONLY:
PAYMENT AMOUNT RECEIPT# DATE:
Application fee
=$ 35.00 _________ _______
Member fee =$150.00 _________ _______
Deposit =$1,000.00 _________ _______
Pro-Rate R&B =$ _________ _______ Approved/not
approved: __________________
Reservation fee
(1st R&B) $500.00 _________ _______
Executive
Director