Application Form Please fill in the form below Personal details First name(s): Last name: Gender / Preferred pronouns: Your gender could be male, female, or whatever other gender you identify as. Your pronouns are how you would like us to refer to you, such as he/him, she/her, they/them, etc. Date of birth: Ethnicity: Religion: House number/street name: Town/city: County: Postcode: Email address: Contact phone number: About you and your household's needs Preferred language: Other languages spoken: Do you smoke?YesNo Do you own any pets? Do you have any dependents who will be living with you? If so what are their names and ages? What size flat are you applying for?1 bedroom2 bedrooms3 bedrooms If you are planning to share the flat with another adult please enter their name so we can consider your memebership together Do you have any access requirements (e.g. ground floor access needed, hearing aids in meetings, BSL interpretation) About your financial situation Do you work? If so what is your rough income level?NoLess than £10,000£10,000 - £20,000£20,000 - £30,000£30,000 - £40,000More than £40,000 Are you currently claiming housing benefits / universal credit / PIP? If so, which? Eligibility Do you own a property? YesNo Do you understand that there will be no Right to Buy on any properties in the Stirchley Cooperative Development?YesNo Describe your connection to the local area Are you planning to bring any vehicles with you? Co-op living Why do you want to live in a co-op? Have you ever been involved in a co-operative organisation before? Do you feel that you would have the time and capacity to contribute to the work involved in living in SCD? Which working group(s) do you think you might be interested in joining?MembershipUpstairsOutdoor spacesFinanceTech & I.T.SecretarialPublicity & OutreachSupport & InclusionDemocracy Further questions Is there anything else you would like to tell us about yourself or your household? Do you have any reservations or concerns about being a member of SCD? Do you have any further questions about SCD?