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The following questionnaire will assist us in making an appropriate housing assignment. Although we make no guarantees, we try to consider as many of your requests as possible based on the information you provide and the rooms and/or roommates available. Please give the following questions ample consideration to provide us with the most accurate picture of you and your housing needs.

This form is for transfer students. If you are a first-year student entering college for the first time, please click here.

Name:

(Last) (First) (MI)
Address: (Street) (City) (State)
Home Phone:
Cell Phone: (optional)
Age: Birth Date: / /
Sex: Male Female
Email Address:
Years of College/University Experience:

(ANSWERS KEPT CONFIDENTIAL)

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 allowed in residential facilities, some students choose to consume alcohol off-campus which can result in roommate conflict. This information will be used only in determing 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 substance-free area if one is instituted? (Yes) (No)

A substance free area is a residence hall setting where students promise to refrain from alcohol and drug use by signing a contract.

H) Do you have a physical/medical condition that requires special placement? (Yes) (No)

(If your answer is yes, you will need to use the print version of this form and attach a physician's statement.)

I) Are you interested in a specific roommate? That person is:

(Both persons must request each other.)

J) Please prioritize your residence hall choices as 1 (top choice), 2, and 3:
Andreen
Erickson (students with a medical need for air conditioning will be given priority)
Westerlin
Swanson Commons (please note that rooms are considered "premium" and cost 15% more than our traditional rooms.)

Would you be interested in a single room if it was available? (Yes) (No)
If we have openings in our Transitional Living Areas, would you be interested?
(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

My ideal roommate would have the following qualities:

Are there particular attitudes or behaviors that make you uncomfortable?

Is there any additional information you would like to have considered in your housing assignment?

Could you please re-enter your last name for record-keeping purposes?