I. Personal Information

1. Name
Last*
First*

Preferred Name

2. Home State Choose... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

3. Country (other than US)

4. Email*

5. Are you a transfer student?*
Yes; if yes, class year 20
No

II. Personal Preferences

1. What is your preferred room temperature?*
65 degrees or lower 70 degrees 75 degrees or higher

2. When do you generally go to bed?*
9pm or earlier 10pm 11pm midnight 1am or later

3. When do you generally wake up?*
6am 7am 8am 9 am or later

4. I would characterize myself as*
light sleeper (easily awaken by light or activity in room)
heavy sleeper (able to sleep with quiet noise or light in background)
a little bit of both

5. If there is someone with whom you would like to share a room, please indicate the student's name. Requests must be mutual for the Office of Residential Life to consider the assignment and both requests must be received by June 9.

III. Academic Habits

1. My intended academic major is*
Choose a field of studyAfrican American and African StudiesAmerican StudiesAncient StudiesAnthropologyArchitectural StudiesArt HistoryArt StudioAsian StudiesAstronomyBiochemistryBiological SciencesChemistryClassicsComplex Organizations ProgramComputer ScienceCritical Social ThoughtDanceEconomicsEducational StudiesEnglishEnvironmental StudiesEuropean StudiesFilm StudiesFrenchGeographyGeologyGender StudiesGerman StudiesGreekHistoryInterdepartmental CoursesInterdisciplinary MinorsInternational RelationsItalianJewish StudiesLatinLatin American StudiesMathematicsMedieval StudiesMusicNeuroscience and BehaviorPhilosophyPhysical Education and Athletics (pe; no credit)Physical Education and Athletics (phyed; for credit)PhysicsPoliticsPsychologyPsychology and Educational StudiesReligionRomance Languages and LiteraturesRussian and Eurasian StudiesSociologySpanishStatisticsTheatre Arts Undecided Other

2. The bulk of my studying occurs in the (select hours) MorningAfternoonEveningLate evening *

3. The bulk of my studying takes place in (select location) My roomThe libraryComputer room *

4. I am not able to study in this type of environment:*

IV. Room Environment

1. I would characterize myself as*
neat and clean messy person somewhere in the middle

2. I enjoy this type of music: *

3. How do you feel about borrowing or sharing things (refrigerator, stereo, television, etc)? *

4. Please indicate the appropriate responses below:*

V. Room Expectations

1. How much time do you expect to be alone in the room?

2. This is how I feel about alcohol use in the room:

3. This is how I feel about drug use in the room:

4. Do you smoke?*
Yes, I smoke No, I am a non-smoker

5. Would you live with someone who smokes?*
Yes No (All Residence Halls are smoke free)

6. When do you feel it is too late to receive calls at night?
After

7. What time is too early in the morning?
Before

8. How much time will you spend on the telephone/computer?
(indicate hours per day)

9. This is what I expect from my roommate:

10. When conflict arises with my roommate, this is how I will deal with it:

11. This is the type of social life I am expecting in the room and on campus:

VI. Community Specific Preferences

1. Quiet Floors*
There are two quiet floors available on campus. A quiet floor is one on which the residents agree to a higher standard of quiet than exists elsewhere on campus. Generally, residents agree to guidelines in which no noise from televisions, stereos, or loud voices are audible outside one's own room. Floor members may decide to relax their guidelines for particular social events.The quiet floors are located on the third floor of Abbey Hall and North Mandelle Hall.

I have no objections to being placed on a quiet floor.
I would prefer NOT to being placed on a quiet floor.

2. November and March Break Periods*
All residence halls remain open for the November and March break periods. Meals are not served and minimal level of campus services are available. The New Residence Hall is the one hall open for December break and is open only for domestic and international students whose families live abroad. New Residence Hall residents who do not meet the criteria to stay for the December break are required to lend their rooms to students who must stay.

I have no objections to being placed in the New Residence Hall.
I would prefer NOT to being placed in the New Residence Hall.

3. Substance Free Room
Substance Free Living is defined as a room with a higher standard of living free from the use or impact from the use of alcohol, tobacco, illegal drugs, and misuse of over the counter and prescribed medicines. Residents would also agree to refrain from the glamorization or celebration of the use of substances in decoration (posters), apparel, and paraphernalia. Use includes use in or out of the residence halls (i.e. you could not come back to the residence hall after drinking). Room residents agree to their guest(s) adherence to this standard while in the room. (i.e. you would not allow your guest to come back to the room under the influence).

Breach of this substance free living agreement may result in housing reassignment in addition to outcomes connected with violations of the campus smoking, alcohol, and drug policies.

I would like to be placed in a substance-free room.

4. Your choice of residence hall, if you have a preference. Please note that selecting a preference does not guarantee placement into a certain hall:*

Choice 1: choose one AbbeyBrighamBucklandDickinson1837HamMacGregorMeadNorth MandelleNorth New North RockefellerPearsonsPearsons annexPorterProspectSaffordSouth MandelleSouth New South RockefellerTorreyWilder
Choice 2: choose one AbbeyBrighamBucklandDickinson1837HamMacGregorMeadNorth MandelleNorth New North RockefellerPearsonsPearsons annexPorterProspectSaffordSouth MandelleSouth New South RockefellerTorreyWilder
Choice 3: choose one AbbeyBrighamBucklandDickinson1837HamMacGregorMeadNorth MandelleNorth New North RockefellerPearsonsPearsons annexPorterProspectSaffordSouth MandelleSouth New South RockefellerTorreyWilder

VII. About Yourself
Please use this space to tell us a little bit about yourself. Feel free to outline any lifestyle/cultural specifics that will help in making a roommate assignment (i.e. religious customs, hobbies, extracurricular/sports activities, social life expectations, etc.).

VIII. Disability/Special Needs

Please indicate any special needs that will affect the specific location of your placement on campus (i.e. within building, campus, type of room). If you have a special need that requires a specific type of placement, please contact the Office of Disability Services.