Residence Life Survey

First Name:

Last Name:

Type of Student:

Freshman   Transfer   International Student

Street Address:

City/Town:

Zip code:

Phone:

Cellphone(xxx-xxx-xxxx):

Email:

Class year:

Freshman   Sophmore   Junior   Senior

Age:

Date of Birth:

(MM/DD/YYYY)

Incoming students are generally assigned to double room accommodations. Singles are extremely limited. You may indicate a preference for a single below, however, single spaces are not guaranteed.

Room Preference:

Double Room Double Room with Assigned Roommate Single Room 24-Hour Quiet Floor

I would like to room with:

First Name:

Last Name:

Address:

Building Preference:

Founder's Hall O'Connor Hall

Please answer the following questions as honestly as possible. We try to use the information below when selecting roommates. Answers to these questions does not guarantee placement, it is merely a guide for us to consider.

1. What is your anticipated major?
   Select a Major Allied Health American Studies Applied Science Art Bio-Chemistry Biology Business Chemistry Communication Computer Information Systems Computer Science Education English Gerontology Global Studies History Justice Studies Mathematics Music Nursing Nutrition Philosophy Physical Education Political Science Psychology Sociology Theology Women Studies World Languages


2. When do you study?
   Morning   Afternoon   Evening  


3. What type of environmnet do you need when studying?
   Completely Quiet   Some Noise   No Preference  


4. What time do you typically go to bed?
   9 to 11 p.m.   11 p.m. to 2 a.m.   2 a.m. or later  


5. What are your interests?
   

   Talking on the phone	Going out with friends	Surfing on the Internet
   Reading	Sports	Listening to music
   Hanging out with friends at home	Watching TV	Other

   Other Interests (please specify):
   
6. Describe Yourself:
   Outgoing   Reserved  


7. What type of music do you like?
   


8. Do you smoke?
   Yes   No  


9. If yes, how often?
   Rarely   Sometimes   Often  


10. Would you mind being placed with a smoking resident?
    Yes   No  


11. If you are a first year student, what high school did you attend?
    


12. Would you prefer to live with a resident from your high school?
    Yes   No  


13. What was your favorite high school activity or club?
    


14. How neat are you?
    Extremely Neat   Moderately Neat   Not Neat  


15. Would you like to have the opportunity to live with an international student?
    Yes   No  


16. If you are an international student, would you like to have the opportunity to live with an American student?
    Yes   No  


17. How often will you plan to visit home?
    Rarely   Sometimes   Often  


18. Would you prefer to share items with your roommate (e.g. refrigerator, TV, cleaning supplies, etc.)?
    Yes   No  


19. How often do you anticipate having guests?
    Rarely   Sometimes   Often  


20. Do you have any medical/health conditions that would affect your housing assignments?
    Yes   No  
    * If yes, you must contact Disabilities Services at 973-290-4261 and speak with the Disabilities Coordinator regarding placement in housing.


21. Additional Comments:
    

Please enter in your parent or guardian contact information:

Parent/Guardian Name:

Day Phone:

(including area code)

Evening Phone:

(including area code)

In the event that you were to go missing who would you like the College to contact:

Contact Name:

Relation to you:

Day Phone:

(including area code)

Evening Phone:

(including area code)

Allergies/Medical Conditions:

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