Required fields are denoted with a *

Last Name: * First Name: * Middle Initial: *

Date of Birth: * Age: * Gender: * Male Female

Address *

Home Phone: * Cell Phone: *

Student Email: *

Parent/Guardian Name(s): *

Parent/Guardian Address: *

Parent/Guardian Contact Number: *

Parent/Guardian Email: *

Would your parents like to be registered for the Parent's Electronic (email) Student Life Newsletter? *

Yes No

Roommate Request:
(Both roommates must make the same request in order for the request to be considered)

Building Request 1^st Choice: * Building Request 2^nd Choice: *
(Options include Florence West, Harter Hall, Sawhill Hall, and Hodge Hall for freshman students. Upper class students may choose Stewart Hall or Bane Hall. Apartments and Theme houses have limited availability and are only open to upper class students. All building requests are based on availability. Please read the housing cost brochure as cost of living may vary per building)

Note: If you choose Hodge Hall as one of your building preferences, please note that you then agree to the extra charge of $200 per semester to live in Hodge Hall if you are placed there.

College Major/Minor: *

Do you smoke? * Yes No Do you object to rooming with a smoker? * Yes No
(Please note that ALL residence halls and buildings on campus are smoke free)

Sleep:

Do you go to bed early or late? * Early Late
Do you wake up early or late? * Early Late

Setting:

Do you like to study in a quiet setting or with background noise? * Quiet Noisy

Personality:

Which of the following words best describes you? * Outgoing Shy/Quiet Easygoing

On a scale of 1–10 ("1" being extremely messy and "10" being extremely clean) how clean do you keep your room? * 1 2 3 4 5 6 7 8 9 10

How would you describe a "bad roomate"? *

Music Preferences (check all that apply)

• Rock
• Pop
• Hip Hop
• Country
• Classical
• Jazz
• Punk
• R&B
• Contemporary Christian
• Oldies
• Ska
• Gospel
• Rap
• Alternative
• Acoustic
• Metal
• Show Tunes

Which of the following activities will you consider participating in at Thiel College? (check all that apply)

• Athletics (which sports? )
• Intramurals
• Campus Ministry
• Greek Life
• Marching Band and/or Concert Band
• Theatre/Fine Arts
• Student Government (SGA)
• Choir
• Community Service Organizations
• Thiel World Organization (International Group)
• Multicultural Affairs Groups/Organizations
• Honor Societies
• Thiel College Shooting Club

Is there any additional information you would like us to know when we consider your placement with a roommate?

Please note: All roommate assignments are made without regard to race, religion, creed, handicap, or national origin, and any requests based upon these criteria cannot be honored. All students are required to live in the residence halls for eight semesters. Exemptions to this policy are outlined in the Student Handbook. Any questions, please contact Rhonda Laird, Housing Coordinator, at 724-589-2198.