WALNUT HOUSE COOPERATIVE - Membership Application Cover Page

For more info, leave message at (510) 549-3140 or send e-mail to walnuthousecoop@gmail.com

A. General information:

Name(s) of applicant(s)	day phone #	evening phone #	e-mail address
1.
2.

B. Information about additional household member(s), if any:

Name	relationship
Name	relationship
1.
2.

C. Monthly gross household income information:

Name	source(s)	monthly gross

1.

2.

D.	Will you have to borrow money for the down payment/share of the unit? If “yes,” please state the expected source of the loan, or indicate if you will need assistance in identifying a source.

E.	Do you hope to have pets if accepted? If "yes," please describe:

F.	Please fill out and attach "Individual Applicant Information" forms (parts 1, 2 and 3) for EACH adult applicant for a unit.

G.	In signing below, I certify that the above statements are true and correct. I understand that if I am provisionally offered membership, I will need to provide a credit report and contact information for current/present landlords and employers, and individual references if necessary to assess my suitability for membership. (By typing my name in the box below, I certify this as legally representing my signature.)

Applicant 1:	Applicant 2:
Date:	Date:

Individual Applicant Information - Part 1: Personal History

Please fill out and attach “Individual Applicant Information - Part 1” for EACH adult applicant.

Applicant Name:	Date:

A. Housing

Please provide your housing history for the last 5 years, starting with your current situation. Go back more than 5 years if needed to list at least 3 residences. Please use additional sheets of paper if necessary.

start date	end date	address	house/apt.?	rent/own?
1.	present
2.
3.
4.
5.

B. Employment

Please provide your employment history for the last 5 years, starting with your current situation. Go back more than 5 years if needed to list at least 3 jobs. Please use additional sheets of paper if necessary.

start date	end date	type of business	position/type of work	Salary
1.	present
2.
3.
4.
5.

Individual Applicant Information - Part 2: Skills Inventory

Please fill out and attach “Individual Applicant Information - Part 2” for EACH adult applicant.

Applicant Name:	Date:

As described in the informational materials, all members have the obligation to participate in the governance, management, maintenance, and improvement of the property. Below is a listing of some of the things we do or would like to be able to do: please put an "x" in the box to the left of any skills in which you have some experience and/or knowledge. Please add at the bottom of the page any other skills you have that you think might be useful and that aren’t listed here. Please do not be intimidated or discouraged if you are unable to check many items. Many factors are considered in selecting new members: skills are only one of them!

General/Community

volunteer coordination

leadership/supervision

developing training procedures & materials

Governance

taking minutes

meeting facilitation

consensus decision-making processes

Board of Directors experience

conflict mediation

drafting policy proposals

Finance & Business

bookkeeping

budgeting & financial planning

taxation of cooperatives & other businesses

familiarity w/ insurance and/or contract law

knowledge of Quickbooks accounting software

Maintenance

painting, incl. proper preparation

refinishing stained/varnished wood

plumbing

carpentry - rough and/or finish

window repair & replacement

masonry & concrete

metal work - sheet metal, welding, etc.

electrical - low voltage and/or 110 systems

steam heating systems

grouting/sealing of tiled surfaces (counters, etc)

linoleum repair

carpet repairs

design of space-efficient work/living spaces

contracting & project management

Computer

Windows hardware/system management

knowledge of MS Office software

spreadsheets (MS Excel)

accounting (QuickBooks)

website development & maintenance

electronic data security, incl. change control

Individual Applicant Information – Part 3: General Questions

Please fill out and attach “Individual Applicant Information – Part 3” for EACH adult applicant.

Applicant Name:	Date:

Please answer each of the following questions. In completing this application in “Word,” simply insert your answers after each question: it doesn’t matter how many pages result. If completing by hand/typewriter, please attach additional sheets of paper for your answers to questions that require more space than is provided: if you do this, please remember to number your answers.

1. Why are you applying to become a member of our housing cooperative?

2. Do you know any current or former members of Walnut House Cooperative? If so, please list each of them and identify your relationship to them:

3. How did you hear about Walnut House Co-op?

4. Have you had any experience living in a housing cooperative or with other types of cooperatives or in other group living situations?

5. Have you participated in volunteer (unpaid) community work during the last 5 years? Is so, please briefly describe the organizations/projects, the work done, when and how often and for how long?

6. What are your experiences with group decision-making and with working as part of a team/group to accomplish a task?

7. How would you describe your strengths and weaknesses in group decision-making, problem solving and doing tasks as part of a group or team? What do you see as advantages or drawbacks of such group efforts?

8. On average, how many hours/month do you think you could contribute to our housing cooperative if you are accepted?

9. Based on the specific skills or experience listed in Part 2, what kind of work and activities do you think you would most enjoy doing? least enjoy doing?

10. What, if anything, would prevent your participating in weekend "workdays" or in General Membership meetings held periodically on Sunday evenings?

OPTIONAL: Please provide any other information that you think will help us understand your interest in joining the co-op and in evaluating what kind of member you would be.

Walnut House Co-op Selections, DEADLINE: Sunday, January 9th, 2011

5

File: 2011-01-WHC-application.dot	Page 2 of 5

Submit to Walnut House Co-op Selections, 1740 Walnut Street, Berkeley CA 94709

Email as an attachment to walnuthousecoop@gmail.com DEADLINE: Sunday, January 9th, 2011

File: 2011-01-WHC-application.dot	Page 1 of 5

Walnut House Cooperative Membership Application 2011

Walnut House Cooperative

2010-12-24

Lee Trampleasure

Walnut House Cooperative