YOUR NAME*

PHONE NUMBER*

EMAIL*

APARTMENT RENTED (if applicable):

BEDROOM PREFERANCE
LeftRightCenterNo Preference

MOVE IN DATE (e.g. 2015-04-08) :

GENDER
MaleFemale

HOW QUIET ARE YOU?
Very QuietMostly QuietAverage

I PREFER A ROOMATE WHO IS...
Very QuietAverageNo Preference

HOW MESSY ARE YOU?
Very CleanMostly CleanAverage

I PREFER A ROOMMATE WHO IS...
CleanerAverageNo Preference

GUESTS:
I prefer a quiet atmosphereI prefer a social atmosphereNo preference

YEAR OF STUDY:
FreshmenSophomoreJuniorSeniorGrad Student

AREA OF STUDY:

YOUR INTERESTS:

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.