Roommate Matching Application
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A PDF version of this application also exists, if you would like to fill out an application by hand please download it here.		 Applicant

Personal Information

First Name:

 Last Name:

Address line 1:


Address line 2:

City:

(Bloomington)		 State/Province:

(Indiana)		 Zip:

(47401)

Home phone number:

 Cell phone number:

Current email address:

Age:

 Gender:
Male Female

Preferences


Preference of roommate gender:
Male Female Either

I would describe myself as:
Very Neat Somewhat Tidy Untidy

I would describe myself as a:
Morning Person Night Person Neutral

I would describe myself as:
Quiet Average Noisy

I am a smoker:
Yes No

I drink:
Often Occasionally Seldom Never

It bothers me when others:
Smoke Drink Both Neither

Known Allergies:


Special Hobbies or Intrests:


Student Information (if applicable)



School Attending:

Major:

(Business) 		Year:

(Senior)

I study:
Often Occasionally Seldom


Employment Information


I work:
First Second Third

Employer Name:
 Occupation:

Terms

Do not submit application unless image is displayed.
Do you agree to the terms above?
Yes No
Date:

 Applicants full name:
Additional comments about your application:


Please type the code below, in all capital letters.
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