UNIVERSITY TOWERS SINGLE LIABILITY LEASE

ROOMMATE MATCHING

NAME: _______________________________________________________________________

TELEPHONE: _________________________________________________________________

EMAIL: ______________________________________________________________________

APARTMENT RENTED: _______________ BEDROOM: ______________________

MOVE IN DATE: _____________________

PLEASE CIRCLE THE APPROPRIATE DESCRIPTION OF YOURSELF:

MALE FEMALE

PREFER QUIET ATMOSPHERE PREFER SOCIAL ATMOSPHERE

YEAR OF STUDY: FRESHMAN SOPHOMORE JUNIOR SENIOR GRAD

AREA OF STUDY: _____________________________________________________________

INTERESTS: _________________________________________________________________

______________________________________________________________________________

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I agree to allow University Towers to place another resident (matched on the basis of gender) on a single liability lease in the above listed apartment. I also agree to allow University Towers to provide the information listed above to potential residents seeking single liability leases. University Towers will attempt to provide a roommate as closely matched to the above information as possible, however, I understand that University Towers is not responsible for the success of the roommate match.

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Name Date