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A) Do you smoke? Yes No
B) Would you be willing to live with a roommate who smokes? Yes No
C) Will you consume alcohol? Yes No
Although alcohol is not permitted in residential facilities, some students choose to consume alcohol off-campus which can result in roommate conflict. This information will be used only to determine roommate pairings.
D) Are you willing to live with a roommate who consumes alcohol? Yes No
E) Do you anticipate hosting guests of the opposite sex overnight during established visiting hours? Yes No
F) Are you comfortable with your roommate hosting a guest of the opposite sex overnight during established visitation hours? Yes No
G) Would you be interested in living in a healthy living area if space is available? Yes No
A healthy living area is a designated area within a residence hall where students sign a contract promising to refrain from bringing the behaviors associated with alcohol, tobacco and drug use back to the residential setting.
H) Do you have a physical/medical condition that requires a specific housing placement? Yes No
(If answer to H) is 'Yes', please submit a physician's statement indicating your medical need by fax to 309.794.7152 or by US Mail to Augustana College; Residential Life; 639 38th Street; Rock Island IL 61201. This includes, but not limited to, severe allergies and/or asthma that requires an air conditioned environment. All documentation must be received by June 1; documentation received after June 1 will be accommodated if space is available.)
I) Are you interested in a specific roommate? That person is:
(Both persons must request each other.)
Would you be interested in a single room if it was available? Yes No
Please note that single rooms cost approximately 30% more than standard double beds.
Swanson Commons East suites are designated for first-year students. Would you be interested in Swanson Commons? Yes No
(Please note that Swanson Commons East rooms have semi-private bathrooms and due to this added amenity cost 15% more than standard double beds)
Transitional Living Areas (TLAs) are a compilation of townhouses, apartments and houses owned by the college that offer third year students (and some second years) more independent living than traditional residence halls. Room rates in these areas vary based on amenities. Meal plans are optional in TLAs.
Are you interested in residing a TLA? Yes No
On the following continuums, please click the answer that best describes you:
Prefer room to be quiet/studious 1 2 3 4 5 See room as lively, social center
Willing to share all belongings 1 2 3 4 5 My belongings are for my use only
Early Riser 1 2 3 4 5 Night Owl
Is it important that your roommate be similar? Yes
Neat 1 2 3 4 5 Untidy
Is it important that your roommate be similar? Yes
Quiet 1 2 3 4 5 Outgoing
Is it important that your roommate be similar? Yes
Conservative 1 2 3 4 5 Liberal
Is it important that your roommate be similar? Yes
Select any/all activities you plan to participate in:
Intramural sports - Similar roommate? Yes No No preference
Varsity sports Sport:
- Similar roommate? Yes No No preference
Music/Theatre - Similar roommate? Yes No No preference
Spiritual/Religious - Similar Roommate? Yes No No preference
Fraternities/Sororities - Similar Roommate? Yes No No preference
I spend my leisure time: (select top two activities)
Watching TV
Video Games
Listening to music Favorite type:
Reading
Socializing
Internet/Computer
Please indicate any pertinent information that will help us make the best housing placement for you (examples…behavior that could result in conflict, strong involvement in hobbies/activities, interest in an International student or transfer student roommate, GLBT/Ally, etc.)
Could you please re-enter your last name for record-keeping purposes?
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