Application for:           Summer 2008                          Fall 2008                     Winter 2009

 

Name:  ______________________________________________________________

            Last                                         First                             Middle

 

Birth date: _____________________

 

Gender:           Male                Female

 

Permanent Address:

 

Street:  _____________________________________________

City, State, Zip Code: _________________________________

Home Telephone: ____________________________________

Work Telephone: ____________________________________

Email: _____________________________________________

 

If completing application with a parent or guardian:

 

Parent/Guardian Name: ____________________________________________________

Phone Number: ______________________________________

Email:  _____________________________________________

 

Who should be contacted regarding admissions information?  ______________________

 

Please list any disabilities and/or medical conditions that residential staff should be aware (this can be completed upon conditional enrollment if desired):  ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

Personal Information

Please be thorough and honest in answering the following questions as they assist in selecting appropriate roommates.

 

 

What characteristics to you deem important in a roommate? ________________________________________________________________________________________________________________________________________________

How often do you clean your room?  ________________________________________________________________________

 

What time to you wake up/go to bed? ________________________________________________________________________

 

Describe the family environment in which you live (who do you live with, how what household duties to you handle…):  ________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Do you know how to cook? ________

If yes, please describe your favorite meal to prepare: ________________________________________________________________________________________________________________________________________________

 

Do you know how to do your own laundry? ____________

Are you working to complete your HS diploma or GED? __________

Please circle the words that best describe your personality:

 

Honest                                     Open Minded                          Understanding

 

Witty                                       Private                                     Outgoing

 

Moody                                                Independent                            Conservative

 

Quiet                                       Talkative                                 Easily Frustrated

 

Casual                                     Introverted                              Detailed

 

Extroverted                             Patient                                     Ambitious

 

Circle the word that best describes your housekeeping habits:

 

Cluttered                     Casual             Clean               Neat                White Glove