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:

Middle Name:

Last Name:

Street Address:



Zip Code:

Home Phone:


Student Status:

              First Year

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 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.

Lifestyle Preferences:
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:
           A smoker
           An occasional smoker
           A non-smoker

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

3. How do you feel about having male guests in your room, including overnight stays?
            It is important that I am able to have male guests, including overnight visits
            I am ok with having male guests during the day/evening, but not overnight
            I would prefer not to have male guests in my room

4. How often would you be comfortable with having visitors in your room?
            I love 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:
            An introvert (I recharge by spending time alone.)
            An extrovert (I recharge by spending time with others.)
            Equally introverted and extroverted

6. Which of the following best describes your preferred study environment?
            I prefer total quiet while reading or working on homework.
            I can study in quiet or with noise Ė I donít have a strong preference.
            I prefer to have music or a television on while I study.

 7.  Which statement best describes how you feel about noise while you sleep?
            I am a light sleeper and do not like music or other noise while sleeping
            I can tolerate some noise
            I am a heavy sleeper and do not mind noise while sleeping

8. Which statement best describes how you feel about light while you sleep?
            I have a hard time sleeping with any light (overhead, windows, electronics)
            I can tolerate some light
            The level of light in the room doesnít matter to me when trying to sleep

9.   What time do you usually get up?
            Before 8am
            Between 8am and 10am
            After 10am

10. What time do you prefer to go to bed?
            Before 10pm
            Between 10pm and 12am
            After 12am

11. Which best describes your sleep needs?
            I adjust when/how much I sleep to fit my schedule
            I consistently sleep an average amount each night
            I sleep all the time
            I 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
            I 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):



Male Guests


Visitor Frequency




Study Environment








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.
            No preference

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)


20. Wellness

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 interested
           No 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.

Student Signature:         Date: