Share Return Form

Please fill out the form if you are not moving back into the ICC (have no future contracts).

House Name:
Member Name:
Last Contract Term:
Last Contract Year:
(Shares are returned twice a year based on the last contract period during which the member had a contract. Fall/Winter shares are returned by the end of the following October and Spring/Summer shares are returned by the end of the following March.)

1. Address where my Rebate/Share should be sent
Address:
City:
State:
Zip:
Country:
Additional Contact Information
Email:
Phone Number:

2. Is this where ICC Alumni information should be sent?
:

3. Early Share Return Eligibility-- I understand that if I receive an Early Share Return I will not be given any rebate or charged an assessment.
Please check all that apply:
a. I am leaving the country:
b. I was replaced or released within 8 weeks of the beginning of a contract:
c. I had a non-standard contract as defined in Standing Rule 4.5.9:
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4. We would appeciate your input and ideas. Please answer the following short questions.
a. Are You:
Graduating and moving out of Ann Arbor:
Moving to a private apartment:
Moving to a small house:
Other:
b. Would you recommend ICC cooperative houses to others?:
Comments:
c. What was the best part about living in an ICC co-op?:
d. Do you have any suggestions for improving the ICC cooperatives?:
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5. Would you like to donate money from your shares to the ICC?

I would like to donate $:
from my shares for:
My house for improvements:
The ICC Development Fund to provide more cooperative housing for students:
Scholarship Fund:
other: