Form Test | NNCC

NNCC Membership

Each individual applicant must complete a separate application and separately furnish the required supporting documentation (see below). Group or family applications are not permitted.
Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email*
Neighborhood Area
Please check the box of the neighborhood where you reside or work
- Arlington Heights
- Goose Hollow
- Hillside
- Linnton
- Northwest Industrial (NINA)
- Northwest District (NWDA)
Please select one of the two options below as the basis of your application:
- I now reside in the neighborhood area noted above and have resided there for more than 30 days prior to this application
- I am the delegate of a business, property owner, government agency, or other non-profit organization in the neighborhood area noted above.
Address:
Name of entity:
An entity may only be represented by an individual who is an owner, operator, officer, director or employee and who is specifically designated as the entity representative in writing on the entity letterhead.
Please Attach a File Showing Proof of Residency
Drop files here or

Accepted file types: pdf, jpg, jpeg.
Acceptable proof of residency or other basis for membership eligibility includes:

For residents, a copy of a driver’s license or other government issued photo ID showing your residence address or a utility bill directed to applicant at address cited.
For property owner applicants, a copy of a property tax statement or deed.
For business owner applicants, a copy of a business license or utility bill. Business owner applicants should also attach a designation letter from the business or property owner etc. naming the delegate as its designated as the entity representative. The letter must be on letterhead and must be signed by an individual having the authority to make this designation. Acceptable file formats are pdf, jpg, and jpeg only (file size limit of 16MB).
Membership Application*
- I hereby apply for membership in the Northwest Neighborhood Cultural Center non-profit corporation and affirm that I am at least 18 yeas of age and that the above information is true.