Office of Housing & Residence Life
New Student Housing Preference Form
Welcome to Hollins!  We hope that you are excited to become a part of our residential community!  In order to be assigned housing, new residential students must complete and submit this form in its entirety.  If you have any questions or concerns, please contact Nickie Smith, Director of Housing & Residence Life at csmith3@hollins.edu or (540) 362-6281.

General Information:        
First Name:   Last Name:   Prefer To Be Called:  
Hometown:   State/Country:   Preferred Contact Phone:  
Email:   Intended Major:   Student Status: First Year, Transfer 

Lifestyle Preferences:      
I am a: Smoker Occasional smoker Non-smoker   
I prefer a rommate who is a: Smoker  Occasional smoker  Non-smoker   
I most prefer my room to be: A place to study  A place for people to hang out A place for me to relax A place for me to sleep 
When I have free time on the weekends, I am most likely to: Have friends over and socialize  Study in the room  Rest and catch up on sleep   Participate in campus activities
When I disagree with someone, I am most likely to: Confront the person right away with my concerns Talk it out with friends or family Let things slide Take the concern to an authority figure
My preferred living space can best be described as: A place for everything and everything in its place Clean, but cluttered  Love me, love my mess  
I plan to have overnight guests: Rarely Occasionally Frequently Don't know yet
I plan to have friends/guests over during the day: Rarely Occasionally Frequently Don't know yet
Assuming my roommate has asked my permission in advance, my level of comfort with male guests is:  
Having male guests in the room is fine as long as they are not overnight guests    
Having male guests stay in the room overnight is fine with me    
I would prefer to not have male guests in the room    

Please use the space below to tell us more about yourself and what you feel is important to know in assigning your roommate.  As you’re writing, some things to consider include:
What excites you about coming to college?
·         What concerns do you have about college?
·         What goals do you have for your college experience?
What academic and co-curricular interests do you plan to explore at Hollins?
·         Have you shared living space with others previously? 
What expectations do you have of your roommate, including the type of relationship you hope to develop with her?
What characteristics and habits do you want in a roommate?
Anything else you think we should know!

Specific Roommate Request:
If you wish to request a particular person as your roommate, please indicate her name here (we will only honor mutual requests):

Interest in Mind, Body, Spirit Community:
Mind, Body, Spirit (MBS) residents focus on exploring holistic personal balance through participation in campus events, creating community activities, and setting community standards that support personal well-being and academic achievement.  Resident Assistants in these communities will provide students with monthly lists of campus events that explore each area of mind, body, and spirit, and residents must attend one event in each per semester.  Additionally, each resident will work with her roommate and RA to plan a hall activity at some point in the academic year.  While each MBS hall will create their own community standards, all MBS residents are required to commit to a substance-free lifestyle.
Example programs from each area include (but are not limited to):
  • Mind:  Academic lectures, Workshops on study skills, time management , stress relief, healthy relationships
  • Body:  Zumba classes, Intramurals, Fatal Vision (alcohol awareness), Health Fair, Couch to 5K
  • Spirit:  Day of Service, Volunteering in the Community Garden, Golden Rule Dinner, Battle of the Bins (recycling), Soul Café (monthly event sponsored by the Office of the Chaplain)
Would you like to be considered for placement in a Mind, Body, Spirit hall? Yes  No 

Housing Accomodations:
The University has a limited number of single rooms, none of which are specifically designated as medical singles.  Housing accommodations are determined on a case-by-case basis by the Director of Housing & Residence Life, the Dean of Students, the Director of Health & Counseling Services, and the Counseling Coordinator. Additionally, the Director of Physical Plant Operations may be consulted regarding the feasibility of a requested accommodation.

Accommodations are approved only in response to appropriate documentation of the medical condition and/or physical/psychological disabilities.  Reasonable accommodations will be made to meet the documented need on a space-available basis.  Specific location requests cannot be guaranteed.  Medical singles are limited to designated single rooms. 

Students requesting a medical single MUST complete the Housing Accommodation Request Form and must have their health care provider fill out the Health Care Provider Form.  Both forms can be obtained from the Director of Housing & Residence Life.  The student may be asked to 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 would be asked to execute the medical release form.

Terms & Submission:
I agree to abide by the rules and regulations of Housing & Residence Life and Hollins University, as well as the community standards of my residence hall. 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 & Residence Life. I also understand that the University has the right to remove me from housing if my conduct fails to meet acceptable standards.  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 & Residence Life otherwise by January 11, 2013.

By submitting this form, I agree to the above statement and confirm that I completed this form myself and that my answers are truthful and accurate.
Student Name:   Date: