Personal Information First Name * Middle Name Last Name * Email Address * Phone Number Street Address * City * State/Province * Postal Code * Date of Birth * Year19561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Co-op Connection Are you a member of a co-op or organization that is a member of NASCO? * Yes No Please select your co-op from this list: - None -4th Street Student Housing CooperativeBitternut CollectiveBloomington Cooperative Living (BCL)Boulder Housing CoalitionBrown Association for Cooperative Housing (BACH)Cambridge Cooperative ClubCampus Co-operative Residence (CCRI)Central PA Community HousingChateau Housing CooperativeCo-op Housing University of Maryland (CHUM)College HousesCommunity Housing Expansion of Austin (CHEA)Community of Urbana Cooperative Housing (COUCH)DeCleyre Cooperative HousingEast River CooperativeEvergreen Co-opFranklin Student Housing CooperativeGenesee Valley CooperativeHorizontal HousingHouston Access to Urban Sustainability (HAUS)ICC Ann ArborICC AustinKalamazoo Collective HousingMadison Community CooperativeMarcy Park Co-opMarquette Climbers' CooperativeMarshall Student Housing Co-opMOSAICMSU Student Housing Cooperative (MSU-SHC)Nickel City Housing Co-opOberlin Student Cooperative Association (OSCA) housingPicklebricolagePortland Collective HousingQumbya Housing CooperativeRad El Dub Community Land TrustRed Clover CollectiveRiver City Housing Collective (RCHC)Rosewood Housing CooperativeSaint Peace HouseSanta Barbara Student Housing Cooperative (SBSHC)Solar Community Housing AssociationStewart Little Co-opStone Soup CooperativeStudents' Cooperative Association (SCA)Student Cooperative Organization (SCO)The Beet CollectiveThe HiveThe MiddenTuring HausUnitarian Universalist Community Cooperatives (UUCC)University of Kansas Student Housing Association (UKSHA)Waterloo Co-operative Residence Inc. (WCRI)Whitehall Cooperative What co-op/organization are you affiliated with, if not a NASCO member Is your co-op * Urban Suburban Rural How long have you been a member of a cooperative? - None -Less than 3 months3-6 months6-12 months1-2 years2-5 yearsMore than 5 years Are other members of your cooperative attending Institute this year * Yes No I don't know Have you attended NASCO Institute before? * Yes No If so, did you receive funding from NASCO to help cover your costs? Yes No I don't remember Financial Information Are you receiving (or have you applied for) funds from your co-op or organization to offset the cost of attending Institute? * Yes No How much have you received or requested? Are you a student? * Yes No Have you applied for funding from your college/university? Yes No Are you financially independent? Yes No Do you have any dependents? * Yes No How many dependents do you have? What is your annual income before taxes (in dollars)? * $ Is your income irregular, or are there other financial considerations that we should be aware of? What is your estimated travel cost (in dollars)? * $ How much funding are you requesting / What amount of funding do you need from NASCO in order to afford Institute? * $ Marginalized Identities A portion of LISF funds will be prioritized for individuals identifying with historically underrepresented groups attending Institute. Do you identify as a member of any of the following identity groups? Person of Color? * Yes No Person with Disabilities? * Yes No Person of Transgender, Genderqueer, and/or Gender Non-conforming experience? * Yes No International Student (studying outside of your home country)? * Yes No Short Response Prompts What will you and your cooperative gain from your attendance at Institute? * Is there any information that you would like to share with us that wasn't covered in the application? Co-op Development Scholarships Are you starting a co-op or expanding a currently existing co-op? We have additional funding available for people working on co-op development projects. Would you like to apply for additional funds to support development? * Yes No What type of co-op are you starting/expanding? How many members will you serve? Who is leading this project? What is your role? What is the next big step? Leave this field blank Submit
