Housing Preferences / Roommate Survey

Residence Life Room Survey Form

Please completely fill out the form below.

Personal Information

Full Name:*

Home Address:*

City:*

State/Prov:*

Zip:*

Country:

Student Phone:*

Student E-mail:*

NOTE: Should you be assigned a roommate, your name, phone number, and email will be provided so that your roommate(s) may make contact with you.

ALL fields must be completed before submitting.
Information will not be saved if you cannot complete all fields below in one session.
Please do not use the ENTER or RETURN key while filling out this form. Use the TAB key to move between fields.

Describe your student status:

First year at Holy Cross College
Returning student to Holy Cross College

Select the term(s) for which you are applying for residence:

Summer Session 2008
2008-2009 Academic Year

Person(s) to be notified in emergency

Full Name:

Home Address:

City:

State/Prov:

Zip:

Country:

Home Phone:

Prices for the 2008-2009 Academic Year are as follows:

Room Type

Apartment	$8500
Single	$8250
Two Room Double	$7900
Double	$7700
Triple including AC	$7400

Variations

Private Bath	$200 added (Basil and James Halls only, very limited availability)
No sink	$50 subtracted (very limited availability)

NOTE: All rooms are equipped with a bed, desk, desk chair, wardrobe or closet and computer port for each occupant. Price also includes the cost of internet service and basic cable. Students have a choice of either using their cell phone or the college phone system for phone contact purposes in their dorm room. If a student chooses to use the college phone system then voice mail is provided at no charge.

Students have the opportunity to indicate a preferred roommate in Step 3. The Office of Residence Life will make every effort to honor such requests when students mutually request each other. Even if you request a specific roommate, or a single room, you are REQUIRED to complete all lines of the following form.

The Director of Residence Life will hand match students who respond similarly to the following lifestyle preference questions. While sorting through hundreds of contracts and matching individuals by hand is a time-consuming process, there are no guarantees that conflicts will not arise. Please keep in mind that living with people from other cultures and backgrounds is also an integral part of the college experience.

In order to ensure that we best understand our future residents, it is asked that neither parents nor any other proxy answer the following roommate preference questions.

Student ID #
Date of Birth
Gender

Male
Female

Do you have a physical disability or a medical concern which would affect your room assignment?

Yes
No

If Yes, please describe:

Have you ever been convicted of a felony?

Yes
No

If Yes, please describe:

1. What kind of a relationship do you want in a roommate?

Do everything together
To be friends
To be respectful and peacefully coexist

2. How do you feel about your roommate using your belongings?

Never a problem using any of my things
OK, but only after asking permission
OK with electronics, but not my personal items
My roommate should not use any of my belongings

3. How often do you clean your room?

Daily
Twice a week
Weekly
Monthly
Before a family visit
When I move out

4. When does your average day begin?

Before 8AM
8-10AM
After 10AM

5. When does your average day end?

Before 11PM
11PM-1AM
After 1AM

6. How would you describe your sleeping habit?

Light sleeper
Heavy sleeper

7. Please check the three (3) types of music that you listen to and enjoy the most:

Alternative	Gospel	Popular
Broadway	Heavy Metal	Punk
Classical	Jazz	R and B
Christian	Latin	Rap
Country	New Age	Reggae
Dance	Oldies	HipHop
Folk	Opera	Other

8. Please check the three (3) ways you most enjoy spending extra time:

Arts and Crafts	Movies	Religion
Comm. Service	Music	Road Trips
Computers	Outdoors	Sports
Dancing	Partying	Television
Dining	Photography	Theater
Family	Reading	Video Games

9. Describe your personality

Quiet
Outgoing

10. You prefer a roommate who is

Quiet
Outgoing

Social Environment: Each roommate has a primary right to the room to which he/she is assigned. With the permission of one�s roommate, guests may be invited into the room.

11. How social do you prefer your room to be?

Quiet and serious
Welcoming to one or two friends at a time
A lively social center where everyone hangs out

12. With the level of noise in my room when I am studying, I

Require absolute silence
Like low background music
Am able to tune out most noises - even loud
Leave the room

Neither smoking nor alcohol is permitted in any Holy Cross Residence Hall. However, as smoking and alcohol consumption manifest themselves in individual behavior, they may impact on roommates.

13. Myself:

I smoke
I do not smoke

14. My roommate:

I prefer my roommate smoke
I prefer my roommate not smoke
I have no preference

15. Myself:

I consume alcohol
I do not consume alcohol

16. My roommate:

I prefer a roommate who drinks
I prefer a roommate who does not drink
I have no preference

17. If you have a particular person you want to room with, type their name here. (NOTE: Roommate requests must be mutual.)

18. Please provide any other important information that should be taken into consideration when placing you in the residence halls. None of the information taken in this survey will be shared outside of the Office of Residence Life.

Student's Personal Health Insurance Information

Name of students Health Insurance Provider:
Insurance Company phone number:
Insurance Policy Number:
Policy under whose name?:

Remember Info?

Need Assistance?

For more information contact:

Br. Chris Torrijas, C.S.C.
Director of Residence Life
Ph: (574) 239-8390
Office: C-106 (Across from Chapel)

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Housing Preferences / Roommate Survey

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