1. Gender:  Male   Female 
2. Age:    Date of birth: 
3. Academic Classification:   Freshman Sophomore Junior Senior Transfer
4. Do you smoke?  Yes    No   Sometimes
5. Would you prefer a non-smoking roommate?  Yes    Doesn't matter 
6. Which describes your musical tastes?  Alternative Country Pop/Rock Rap/Reggae R&B Eclectic (Variety of Styles) Other Other
7. Which of the following describes your room?  Neat and clean Generally neat A little messy Messy
8. What is your sleeping pattern likely to be on weeknights (Sunday through Thursday)?  Early to bed, early to rise Early to bed, late to rise Late to bed, early to rise Late to bed, late to rise
9. What is your sleeping pattern likely to be on weekend nights (Friday and Saturday)?   Early to bed, early to rise Early to bed, late to rise Late to bed, early to rise Late to bed, late to rise
10. What are your social expectations in relation to your apartment and roommates?  I want my room to be a quiet place to get away. I wouldn't mind people in my room sometimes I want people to be around I want my room to be the place everyone hangs out
11. Under what conditions do you like to study?  Absolute quiet background noise okay TV or radio on is okay With other people
12. When do you like to study?  Mornings Afternoons Evenings Late at night
13. Where do you prefer to study? In my room In the library In a study lounge
14. What grades do you typically make?  A's   A's and B's    B's   B's and C's C's
15. How do you feel about lending your possessions? I generally don't like other people using my things I don't mind loaning things to friends I am comfortable with others sharing my belongings
16. Which statement best describes your academic plans? I plan to take classes that are interesting and choose a major later I am planning to major in (please fill in blank)
    Intended major
17. Will you be playing a sport or participating in an activity (ie, ROTC that may require early morning practice/training? Yes No

    Please list any special housing needs that you may have (medical requests must be accompanied by a physician's certification):
   

    Describe yourself and what you enjoy doing during your free time:
   

    What qualities and characteristics are you looking for in a roommate?  Please note: roommate matches are not based on race,     religion, creed, disability, ethnic or national origin, or sexual orientation.  Please do not indicate characteristics relating to those.
   

   We will honor mutual roommate requests when possible.  Often, tenants find that good friends make better neighbors than roommates, and that living with a new person leads to a new friendship.  If you do have roommate requests, please list those names and current phone numbers here:

    Please indicate your preference:  

same-gender roommates

doesn't matter

(*Please note that not all properties have the option of mixed gender accomodations)

Next: Needs & Interest Assessment