HOUSEMATE INFORMATION

 

Please mail back to: Ingrid Stone, Onondaga Community Living, 518 James Street, Syracuse, NY 13203
Or email to: Ingrids@oclinc.org
Or call: 315-434-9597

Name: _____________________ Phone: _____________________

Address: _____________________ Email: _____________________

_____________________

How long have you resided at this address? ____________

Landlord name and phone number: _________________________________

(if less than 3 years at current address)
Previous address: _________________________________

_________________________________

Previous landlord name and phone no. _________________________________

Current Employer: Name, Address, phone _________________________________

_________________________________

_________________________________

How did you hear about OCL? _________________________________

Own transportation?: Y/N
Valid driver’s license?: Y/N

Please tell us something brief about yourself, your personal interests, and your profession.

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Please tell us what makes you interested in becoming a housemate?
_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________