Housing Request

Housing Questionnaire

Instructions:

In order to match roommates as best we can, we request your help by answering the following questions. If you are having problems submitting this form, please email all of the information to pmiller@thiel.edu.

 
Personal Information:
Name (First, Middle Initial and Last Name):    
Mailing Address    
City, State & Zip    
Home Phone Number Parent's Work Phone Number Student's Cell Phone Number
Email Address    
Thiel ID Number (if known)
     
Sex: Female Male
 
Emergency Contact (other than parents):
Name (First and Last Name)
Mailing Address
City, State & Zip
Phone Number
 
Lifestyle Preferences
Do you have a specific roommate request? Yes No
(If at all possible, the Office of Student Housing will meet your request for a specific roommate. Both you and your prospective roommate should note your request on this form, no later than July 1.)
Name of requested roommate
 
Are there special circumstances that necessitate you being assigned to a first floor room?
If Yes, please explain:
 
Do you smoke? Yes No
Would you object to your roommate smoking? Yes No
(Smoking is not permitted in residence hall rooms.)
Can you study with music or TV playing? Yes No
Do you usually: Go to bed early Go to bed late Get up early Get up late
What are your strong personal dislikes?
 
Please let us know of your interests in the following clubs and organizations that may assist us in making your roommate assignment. Please check as many as apply:
 
Athletics/Intramurals
Lutheran Student Movement
Danceline
Global Studies
Yearbook
Honors Program		 Habitat for Humanity
Activities Board
Student Government
Greek Life
Community Service
Newspaper		 Circle K
Ski Club
Radio Station
Theater
Cheerleading
     
Academic Major or Interests    
     
     
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.