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
email@example.com or (540) 362-6281.
Special Housing Accommodations
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
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.
For many students, living on campus will be their first time
sharing a room. Our mission is to ensure that all of our
residents have a space where they can live and study in the way
that best supports their personal development and academic
success. By filling out this form youíre 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, you help us do our best to pair you with someone
who shares your interests.
1. I consider myself:
An occasional smoker
2. Would you be open to living with a smoker?
3. How do you feel about having male guests in your room,
including overnight stays?
is important that I am able to have male guests, including
am ok with having male guests during the day/evening, but not
would prefer not to have male guests in my room
4. How often would you be comfortable with having visitors in
having people over and am most comfortable with frequent guests
I like having people over, just not all the time
I am most comfortable when guests come over by invitation only
5. I consider myself to be:
introvert (I recharge by spending time alone.)
extrovert (I recharge by spending time with others.)
Equally introverted and extroverted
6. Which of the following best describes your preferred study
total quiet while reading or working on homework.
I can study in quiet or with noise Ė I donít have a strong
prefer to have music or a television on while I study.
7. Which statement best describes how you feel about noise
while you sleep?
am a light sleeper and do not like music or other noise while
I can tolerate some noise
am a heavy sleeper and do not mind noise while sleeping
8. Which statement best describes how you feel about light while
have a hard time sleeping with any light (overhead, windows,
I can tolerate some light
The level of light in the room doesnít matter to me when trying
9. What time do you usually get up?
Between 8am and 10am
10. What time do you prefer to go to bed?
Between 10pm and 12am
11. Which best describes your sleep needs?
adjust when/how much I sleep to fit my schedule
I consistently sleep an average amount each night
sleep all the time
donít sleep much at all
12. Which best describes your bedroom at home?
Very messy, I donít like to clean often
I clean on a semi-regular basis
Very neat and organized; I clean very regularly
13. 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
donít have a problem with occasional alcohol use
I disapprove of alcohol use
14. I consider myself to be:
15. Assess this statement: A match based on my level of religion
or spirituality is important to me.
16. Of the questions asked so far, please rank the topics
you feel are most important in determining a good roommate match
for you (1= Most Important 8 = Least Important):
17. First-year students are housed in doubles in Tinker and
Randolph, unless accepted to live in a double in a specialty
house (see below for more information about specialty houses).
Please indicate your preference between Tinker and Randolph if
you have one. While we will do our best to honor your
preference, we cannot make guarantees.
18. Please assess this statement: Who I live with is more
important than where I live.
19. If you have a potential roommate in mind, list her here:
(please note that only mutual requests will be granted)
With two halls in
Tinker and one hall in Randolph, the Wellness halls are our
newest and largest special interest community. Wellness
residents are committed to a substance-free lifestyle and a
personal exploration of what it means to be ďwellĒ in all
aspects of life.
Are you interested in the Wellness hall?
Yes, I am
thank you, I am not interested
21. Please list any additional information or comments
regarding your personal habits: (Limit 255 Characters)
Terms & Submission
In selecting/accepting a room, 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 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 & Residence
Life otherwise by January 13, 2011.