Judson University Christian College: Application Information: Housing Preference Questionaire Form

 

Judson University 

Residence Reservation and Housing Preference Questionnaire

 GENERAL INFORMATION: 
 

Name  (Last)  
 
Name (First)
 		   
 Present Address     
 City   , State   Zip Code

 
 Home Phone     Cell 

 
 Birth date     Age  

 
Gender  
 
Email     
I will be a:
(choose one)
 
 

I am an:     
 		   
Home Church:
 		   
Home Church Affiliation:
 		   
Other Colleges Attended:
 		   
Parent Name(s):
 		   
Emergency Contact 1 Name
 		   
Contact 1 Relationship
 		   
Contact 1 Phone
 		   
Emergency Contact 2 Name
 		   
Contact 2 Relationship     
 		   
Contact 2 Phone
 		   
 
 ROOMMATE PREFERENCE (Please enter the full name of the student you wish to room with (if known).  Both students must mutually request one another.) 
  
Are you an athlete?
 
If you are an athlete, do you want to room with a teammate?
 
If yes, who?  

 

OTHER PREFERENCES 

 Do you have any health needs which require special housing? 

 If yes, please describe your situation:
 
Do you have any health concerns, such as asthma or allergies?

If yes, please describe:
 

Please provide any other health information that will be helpful in placing you in the dorms.

 

Are you a heavy or light sleeper?  

 How many hours of sleep do you require?  

 I prefer to go to bed by . I like to get up by  .

 When is it most profitable for you to study?  

 I prefer a place to study that is  

I keep a room that is  

 In my room, I normally like   

What kind of music do you prefer?
 

 Music Volume (1=Low, 5= High)  

Of the qualities listed below, which 3 would you like in a roommate? Please choose only 3.  

          If you chose other, please indicate what other quality you seek in a roommate:  

What are some of your hobbies and interests?
 

Please list any church activities in which you participate or are involved in.
 

Are there other important issues that would be helpful to the Residence Life staff or personal preferences concerning the type of roommate you desire?
  

 Would you like to have an international student as a roommate?

 
 

Expectations: It is the responsibility of each student to be familiar with and abide by Judson University's Lifestyle Expectations as described in the Student Handbook including alcohol, drugs, tobacco, racism, immodesty, premarital sex, homosexual behavior, pornography, and gambling. Violations of these expectations may result in disciplinary action as described in the Student Handbook.
By placing your initials below, you acknowledge that you have read and accepted the Lifestyle Expectations and policies of Judson University as stated in the Student Handbook. The Housing Office cannot guarantee that all special requests regarding room, roommate(s), or special needs can be met, but all inquires will be evaluated and every effort will be made to meet the request(s).
Those who submit this form with the $175 deposit will be given priority in housing assignments.
Additionally, by placing your initials below, you agree to authorize the release of your general information to your future roommate.