Personal Information
First Name
M.I.
Last Name
Date Of Birth (M/D/Y)
/ /
Gender
Current Address:
Country
Parent/Legal Guardian Address:
Parent/Legal Guardian (1) First Name
Parent/Legal Guardian (1) Last Name
Parent/Legal Guardian (2) First Name
Parent/Legal Guardian (2) Last Name
Same as current address?
Yes No
Contact Information
Phone (1)
Type
Phone (2)
Type
Email Address
Prefferred contact method:
Emergency Contact Information
First Name
Last Name
Phone
Relationship
Term & Program Information
Which term will you move in?
Your program of study?
Student Status
Student Status
Preferences
Do you smoke?
Yes No
Do you mind if your roommate smokes?
Yes No
Do you have allergies?
Yes No
Where do you usually study?
How would you describe yourself?
When do you usually go to bed?
How do you usually keep your room?
How often do you plan to have guests?
Are you comfortable sharing your personal items with your roommates (i.e. TV, stereo, computer, dishes)?
Would you like to tell us anything else?
May we release your phone number and/or email address to prospective roommates?
Yes No