University Cooperative Housing Association

SUMMER SHORT TERM HOUSING APPLICATION

(Housing - July 1^st through September 1^st only)

This application must be accompanied by a $35.00 (US) application fee (non-refundable). The cost to live in the Co-op on a short-term basis is $30.00 per day for stays with no chore requirement (minimum stay 10 days), and $25.00 per day for stays with a weekly chore requirement (minimum stay 30 days). Meals and utilities are included in both these rates. On availability of a space (an application usually takes approximately 2-4 weeks for processing), you will be contacted to confirm acceptance by forwarding payment of the US$500.00 reservation fee which will be credited towards the total rent requirement. The US$1,000.00 (refundable) deposit will need to be paid at check-in along with any balance due on rent.

No offer of housing should be considered confirmed, until in receipt of an official letter, confirming acceptance by UCHA. All payments need to be made in cash, cashier’s check, travelers’ checks, money order or credit card. Please note, we do not accept American Express, the Discover card, wire transfers, or personal checks. The deposit is refunded within approximately 3-4 weeks after your departure, less any charges to your account.

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. Thank you and we look forward to having you stay with us here at the UCHA.

Family Name _______________________First Name____________________________

Street_______________________Apt#______City_______________State___________

Country____________ Phone# ________________Email _________________________

Fax _______________ Sex: Male _____Female_____ Date of Birth ________________

Social Security______________ Passport #________________Country______________

Driver’s License #__________________ State/Country___________________________

Status: Student ____Visiting Scholar ____ Non- student _______ Other______________

Date you would like to check-in________, check-out_______, (please note our official business hours). Option: $30/day_____ $25/day_____, Member _____, Other _________.

Have you lived here before? Yes, ____ No ___, If yes when? From _____ to ________.

Were you Expelled/Evicted __________? If yes Explain __________________________ Have you been evicted by a previous landlord? Yes, ______ No ______ If yes, Explain _______________________________________________________________________.

How did you learn about the Co-Op? ____________________________________.

Have you been convicted of a felony in the last 7 years? Yes ______No________

If “Yes” please explain________________________________________________

I certify that I understand the above, and that the information I have given is correct. I also understand that UCHA reserves the right to make any changes, withdraw any offer of admission/cancel reservation and for no cause. My signature authorizes UCHA to verify my credit and other history, and any or all information listed. I also understand that failure to disclose the truth will be grounds for immediate termination of my contract.

___________________________________________ _______________________. Signature: Date:

I authorize UCHA to debit my credit card #_____________________ expiry_______ For US $_________, 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.

________________________________________________________________________

FOR OFFICE USE ONLY

Application fee =$35.00 ____________ __________ Approved/Not approved:

Express fee = $20.00 ____________ __________

Deposit = $1,000.00 ____________ __________

Rent = $500.00____________ __________ ____________________

Executive Director