Waiting List Application

COOPER LANDING SENIOR CITIZENSCORPORATION, INC.

P.O. Box 552, Cooper Landing, Alaska 99572 ~ Phone (907)595-3000 ~ E-Mail clscci@arctic.net
Wait List Application

SNUG HARBOR SENIOR HAVEN APARTMENTS
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Prospective Resident:

Cooper Landing Senior Citizens Corporation, Inc. (CLSCCI) is always taking applications from prospective tenants, minimum age 55, to add to our wait list for senior housing. To be added to our list, we are asking that applicants let us know of their intentions. Please answer the following questions and send this form to us at the address above. You may scan and e-mail to clscci@arctic.net. Be sure that you contact us if you move or change your phone number.

NOTE: Applications are filed in order received. All units will be filled with qualified applicants in waiting list order.
Name

First NameLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Mobile Phone:
Format: (000) 000-0000.
Co-Applicant:

First NameLast Name
Co-Applicant Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone:
Format: (000) 000-0000.
Mobile Phone:
Format: (000) 000-0000.
Wait List Preference
Apartment Size Preference
Applicant Signature:
Co-Applicant Signature:
Should be Empty:

COOPER LANDING SENIOR CITIZENSCORPORATION, INC.