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