Personal Information

Name:

Phone#

Email:

Gender:

Which method of communication do you prefer?

Academic year

General Questions

How often do you smoke?

How often to you drink?

How often do you go out?

How often do you study?

Do you have visitors?

How often do you cook?

How often do you work?

Rate the following from 1 - 5

How important is it to you that your room be kept neat and orderly?

When/if you study in your room, will music or activity bother you?

How late do you stay up on a regular basis?

Choose all that apply

Lifestyle/Personality

Hobbies

Music Preferences

Requested Roommates

Requested Roommate Name:

Phone#

Requested Roommate Name:

Phone#

By signing below, I understand this information will be made public to other residents in search of roommates. I acknowledge that Landlord is not responsible or liable for any claims, damages, or actions of any nature whatsoever relating to, arising out of or connected with disputes between potential or selected roommates. Landlord abides by Federal Fair Housing Laws when assigning roommates. I acknowledge that Landlord strives to accommodate the desired apartment size and roommate preferences, however Landlord cannot guarantee all preferences can be met. If I do not advise Landlord of my preferred roommates, Landlord will assign a roommate(s) to my unit.

Signature of Applicant (Type in Name)

Date: