1

ALEX GIRVIN HOUSING

CO-OPERATIVE INC.

Please note that is your responsibility to ensure that your application is complete, or it will not
be date stamped on the day received. Here are some of the things that are often forgotten:

1.

APPLICATION FEE:

Cheque or money order made payable to Alex

Girvin Co-op;

2.

PROOF OF INCOME:

Make sure that it is the proper proof for your

particular source of income;

3.

REFERENCE DATE:

Without things like your landlords phone number,

your date of birth, your banks name and address,
we cannot complete proper reference checks, and
therefore your application may be delayed.

Please note that there is no subsidy available. To apply for membership a total gross household
income of $28,000.00 is required. This application is for full market value rent only, which is as
follows:
Two bedroom

$995.00 plus heat and hydro.

Three bedroom

$1,100.00 plus heat and hydro.

Four bedroom

$1,157.00 plus heat and hydro.

75 ALFORD CRESCENT, UNIT 12, SCARBOROUGH, ONTARIO, M1B 4E2

TELEPHONE:
(416) 284-5437
FAX:
(416) 284-4160
E-MAIL:
alexgirvincoop@gmail.com
MANAGER:
Sheri Gibson

ALEX GIRVIN HOUSING

CO-OPERATIVE INC.
A Non-Profit Housing Co-operative

PART I

HOUSEHOLD INFORMATION

HOUSEHOLD MEMBERS

APPLICANT I

Please print clearly and include full names of all

household members. List as applicants all
household members who are applying for
membership. List other household members in
space provided below.
APPLICANT II

Name:
Address:

Name:
Address:

Home Telephone:
Business Telephone:

Home Telephone:
Business Telephone:

OTHER MEMBERS OF HOUSEHOLD:

Surname

Given Name(s)

Relationship to
applicant

Date of Birth

HOUSING NEEDS
Size of unit you need or prefer. (Note a second choice if you are interested in more than one size
of unit).
Two bedroom Townhouse
________________________
Three bedroom Townhouse ________________________
Three bedroom Modified Townhouse____________
Four bedroom Townhouse ________________________
Do you own a pet? Yes _____
No _____
If yes, what kind(s) and how many? ________________________________________________.
Does anyone in your household have any health problems that affect their housing needs? If yes
please specify: _________________________________________________________________
How many bedrooms in your current house/apartment:
We are currently living in a two bedroom apartment and are desperately under-housed for our
family of six. Ideally we would like to remain at Gardenview Co-op; however their waiting list
for a three bedroom apartment or townhouse is several years long. Therefore we have now
started to apply to other co-ops in the Scarborough area where we have built a community of
friends, family and contacts and so that our children may remain at their schools and maintain
their own friendships.

PART II

REFERENCE AND FINANCIAL INFORMATION

This part of the application is confidential and will only be available to those directly involved in
the member selection process and staff.
ACCOMMODATION HISTORY
If the information requested below is not the same for each applicant, please provide additional
information about each adult on a separate sheet.
Present Address:
Length of stay at present address: _______________________________________________
Type of housing:
Own Home ________ Private Rental __________ Rooming House ____
Co-op Housing _____ Public Housing _________
Shared Accommodations __________ (e.g. living with parents)
Monthly costs of present housing:

Rent: ______________________ Per Month

Utilities: ____________________Per Month
(if not included in rent)

Present Landlord or Mortgage company:

Name: ___________________________________ Telephone number: ________________
Address: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Reason for wanting to move ______________________________________________________
_____________________________________________________________________________
Previous Landlord or Mortgage company:
Name: ______________________________________Telephone number: _________________
_______________________________________________________________________
_______________________________________________________________________
May we contact your present and / or previous landlord as a reference?
Yes __________
No __________

INCOME AND REFERENCE INFORMATION

If there are more than two people in your household receiving income, list additional
information to a separate page. Please attach appropriate proof of income to this
application. (see the attached sheet for a description of acceptable proof of income.)
If you are aware of any credit problems that may affect your reference, please provide
any information that might help the Co-op to get an accurate picture of your credit
history.

APPLICANT I
Occupation: Law Clerk
Employer: Aviva Canada Inc.
Address: #4800-100 King Street West,
Toronto, ON
Length of time with present employer: Since
December 2012
If less than one year, please give previous
employer: N/A

APPLICANT II
Occupation: Student
Employer: Strayer University
Address: Online

Gross monthly income from employment:

$
4500
Income from other sources:
$______________
Total Gross Household Income (per Month):
$
4500

Gross monthly income from employment:

Not employed
Income from other sources:
$_____________
Total Gross Household Income (per Month):
$0
_
_____

Date of Birth
December 23, 1974
S.I.N.
495 472 409
Credit Union / Bank: Scotiabank
_____________________________________

Date of Birth
April 9, 1979
S.I.N.
In progress
Credit Union / Bank:
_____________________________________
_____________________________________

Drivers License No.:

Car License Plate No.:

Drivers License No.:

Car License Plate No.:

N/A
N/A

Length of time with present employer: Since

September 2011
If less than one year, please give previous
employer: N/A

7APP19

PART III

PARTICIPATION IN THE CO-OP

All members are expected to participate in some aspect of the Co-ops operation and
management. The Co-op has a number of committees to allow members to have input into the
management of the Co-op and the organization of community activities. Please indicate which of
the following committees would be of interest to you. Note the area of interest for each person in
the household applying for membership. Note first and second choices. Initial your choice if
there is more than one applicant in your household. (See attached for brief Committee
descriptions.)
Membership Committee
Landscape Committee
Finance Committee
Maintenance Committee
CHF Delegate
Kids Activity Committee

Applicant I: Print
Name____________________________________________________________________
1st Committee
Choice________________________________________________________________________
2nd Committee
Choice________________________________________________________________________
______________________________________________________________________________
Applicant II ___________________________________________________________________
Name_________________________________________________________________________
1st Committee
Choice________________________________________________________________________
2nd Committee
Choice________________________________________________________________________
_____________________________________________________________________________

GENERAL INFORMATION
How did you hear about Alex Girvin Co-op?
Have you lived in a housing co-op before?
_______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Why do you want to move into this Co-op?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you been involved with any other volunteer organization such as a community group,
service club or trade union? If yes, please give details.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Any other comments concerning your application to the Co-op?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

I/We understand that only members of Alex Girvin Housing Co-operative Inc. may live in the
Co-op and I/We hereby apply for membership in the Co-operative.
I/We understand that this application must be accompanied by the following:
The twenty dollars ($20.00) application fee per adult household member, not to
exceed forty dollars ($40.00). (This fee is non-refundable. The cheque or money order
should be made payable to: Alex Girvin Housing Co-operative Inc.)
Proof of income in a form suitable to the Co-operative for each member for the
household who receives an income. (See the page for information on Proof of
Income.)
I/We understand that Alex Girvin Housing Co-operative has been formed to provide housing at
cost to its members and that the Co-op relies on the participation of members to operate
successfully.
I/We understand that in order to move into Alex Girvin Housing Co-operative I/We must be
interviewed and accepted for Membership Committee and the Board of Directors of the Co-op.
I/We understand that, if accepted for membership and offered a unit, a one-time membership fee
of twenty dollars ($20.00) will be required.
I/We declare that all the information in this application is correct and authorize the Co-op to
verify any or all of the information contained in this application, and to perform a credit check.

Date:

_________________________________

Signature
Applicant(s)

_________________________________
_________________________________

Date:

_________________________________

Signature
Applicant(s)

_________________________________
_________________________________

PLEASE NOTE:

Your application will not be recorded as received until all information and
the application fee has been received.

PROOF OF INCOME
If you are self-employed or a member of a partnership, submit a financial statement prepared by a
chartered accountant concerning your most recent fiscal period indicating:
the gross and net profits from your business.
total payment from your business to you or members of your household as personal salary, bonus,
dividends, loans or otherwise in the last year; and
If your business does not normally prepare financial statements, submit a letter from a chartered
accountant or a statutory declaration, sworn before a notary public, of your earnings in the past twelve
months and projected earnings for the next twelve months.
If you are regularly employed, submit the following:
1.) a letter from your employer stating your gross wages, overtime pay, or annual salary for the past
year; or
2.) original copies of three consecutive recent pay stubs.
If you are receiving social assistance:
submit a letter from your caseworker or the social agency indicating the size of your family and any
amount of benefits received; or copy of your recent cheque, and slips sent to you with your cheque.
If you are receiving a pension or annuity, submit:
a confirmation letter; or copies of your monthly pension cheque; or
the slips sent to you with your cheques, your earnings for the next twelve months.
If you are irregularly or seasonally employed, submit your last income tax return together with related
T4 slips and the Notice of Assessment issued by Revenue Canada; and
a confirmation letter from your current employer stating your gross wages and over time
and copies of any employment insurance benefits.
If you are currently unemployed, submit:
Employment Insurance benefits correspondence confirming insurance payments.
Call the Alex Girvin Co-op office at (416) 284-5437 to determine how to verify any form of income not
included above.
Return completed application to :
Alex Girvin Housing Co-operative Inc.
75 Alford Crescent
Unit 12
Scarborough, ON M1B 4E2
alexgirvincoop@gmail.com