General Information:

First Name:         Middle:        Last Name:   

Address:                City:            State:         ZIP:   

Home Phone Number:        

Email Address:   

Birth date:           

Student Status:

              First Year
              Transfer
 

Special Housing Accommodation:
Special housing accommodations can be requested by resident students who present conditions, medical or psychological through the Director of Housing and Residence Life. Reasonable accommodations will be made to meet the documented need; specific housing requests cannot be guaranteed. The written request must be supported by a licensed physician and will be subject to review by and the approval of the Director of Housing and Residence Life, the Dean of Students, and the University Health Center. The student must execute a medical release form provided by Health and Counseling Services; if the student is under the age of 18, the parent or legal guardian must execute the medical release form.

Lifestyle Preferences:
For many of our students, living on campus will be their first time sharing a room. Our mission is to ensure that all of our students have a space where they can live and study in the way that best fits their personality. By filling out this form you’re giving us the tools we need to match you with a roommate. We cannot always guarantee a perfect match but by being honest about your habits and preferences we can do our best to pair you with someone who shares your interests.

1. Are you interested in a Wellness hall (substance free, increased quiet hours, focus on total self well-being, selective visitation)?
           Yes, I am interested
           No thank you, I am not interested

2. I consider myself:
           A smoker
           An occasional smoker
           A non-smoker

3. Would you be open to living with a smoker?
           Definitely
           No preference
           Definitely not

4. What is your reaction to male visitors in the room?
            Bring on the boys (Important)
            I could take them or leave them (No strong preference)
            No testosterone for me please (Prefer not)

5. Describe a comfortable flow of visitors in the room.
            The more the merrier (frequent)
            I like visitors, just not all the time (periodic)
            Do not disturb (infrequent)

6. I consider myself to be:
            An introvert
            An extrovert
            Equally introverted and extroverted

7. Which statement best describes your sleep patterns?
            A pin dropping could wake me (light sleeper)
            I can tolerate some noise (average)
            I could sleep through a rock concert (heavy)

8. What time do you usually get up?
             I am up with the sun (up before 8am)
            Pass the caffeine, it takes me a little longer to get up (8am-10am)
            I love to hit the snooze button (after 10am)

9. What time do you usually go to bed?
            I need my beauty sleep (before 10pm)
            I always get tired before Letterman (between 10pm and 12am)
            I like to burn the midnight oil (after 12am)

10. Which best describes you?
            I adjust my sleep schedule to fit my commitments
            I don’t require much sleep at all
            I sleep all the time
            I literally never sleep

11. Which best describes your bedroom at home?
            Call FEMA, its disaster zone
            I shovel it out occasionally
            Everything is organized by shape, size or color

12. My attitude towards alcohol use may best be described as (alcohol is only permitted for students who are 21 and older):
            I am extremely tolerant of alcohol use
            I approve of occasional alcohol use
            I disapprove of alcohol use

13. I consider myself to be:
            Religious
            Spiritual
            Neither

14. Assess this statement: A match based on my level of religion or spirituality is important to me.
            True
            False

15. First year students are housed in doubles in Tinker and Randolph. Please indicate your preference if you have one. While we will do our best to honor your preference, we can make no guarantees.
            Tinker
            Randolph
            No preference

16. Please assess this statement: Who I live with is more important than where I live.
            True
            False

17. If you have a potential roommate in mind, list her here (please note that only mutual requests will be granted).

Please give three adjectives that best describe you.
     ,     ,    

Please list any additional information or comments regarding your personal habits.

In selecting/accepting a room, I agree to abide by the rules and regulations of my residence hall and of Hollins University . I realize that if at any time my room is not filled to capacity, a student (s) may be assigned to fill it. I realize I may not move out of or have another student move into my room without first receiving permission from the Office of Housing and Residence Life. I also understand that the University has the right to remove me from housing if my conduct is dangerous to me or other members of the Hollins community. I am aware that specific housing placement cannot be guaranteed. I authorize the University to provide my name, address, and phone number to my new roommate unless I notify, in writing, the Office of Housing and Residence Life otherwise by July 2, 2008.

Student Signature:      Date: