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Housing Questionnaire

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Housing Questionnaire
Office Use Only
Dorm:
Date:
Housing Questionnaire
– ALL STUDENTS MUST COMPLETE THIS QUESTIONNAIRE REGARDLESS OF YOUR HOUSING NEEDS! –
Student Name
Student #
Address
City
Telephone #
State
Age
Gender
Zip
Male
Female
PLEASE CHECK YOUR START DATE (SPECIFIC TO YOUR COLLEGE):
College of Applied Technologies
Colleges of Business, Health Professions,
and Occupational Professions
January
February
April
May
June
August
October
November
Fall
Winter
Spring
Summer
IN CASE OF EMERGENCY, CALL:
Name
Relationship
Home Phone #
Cell #
I will require on-campus housing
Work #
I will NOT require on-campus housing
The following section is to be completed ONLY if you WILL require on-campus housing.
To secure on-campus housing, a non-refundable deposit of $100 must be received. The deposit will be applied toward your first
housing bill. If you choose to live off-campus later and attend class, the deposit will be credited towards your tuition.
If paying by check, make it payable to: The University of Northwestern Ohio.
The following must be finished prior to any housing assignment being processed:
• Be accepted to the University of Northwestern Ohio
• Complete and return your Housing Questionnaire
• Fulfill your financial obligation for tuition and housing for the first session/quarter
• Be scheduled for classes
Housing Preference: Please rank in order of preference (1 being the highest)
Racers Village ($650 per session or $1300 per quarter)
Sherwood Park ($450 per session or $900 per quarter)
Northwestern Park ($450 per session)
College Park ($450 per session)
SPECIAL ACCOMODATIONS:
If you are disabled or have a medical condition requiring special acommodations, please list them below.
Roommate Information
– PLEASE READ CAREFULLY –
This form does not guarantee that all of your preferences/requests will be granted. This form allows us to best match you up
with someone who shares common interests, values, or a similar schedule. The University reserves the right to make any and all
final housing and roommate assignments during the year for the good of the resident or the residential community, or any other
reason deemed appropriate by the University. It is in your best interest to answer these questions as honestly and completely as
possible.
Roommate Request: If you wish to room with a friend, you both must request each other by name. Both students must apply and
be accepted for admission to the University, complete all housing forms, pay the $100 deposit, and have an academic schedule for
the session or quarter before a room will be assigned.
Name of person/people with whom you wish to room:
PLEASE CHECKMARK THE ANSWER TO EACH OF THE FOLLOWING QUESTIONS:
I am a:
Non-Smoker
Smoker
Occasional Smoker
I go to bed at:
10-11pm
12-1am
2am or later
I am more active:
in the morning
in the evening
I would describe myself as:
very neat
usually neat
messy
I would describe myself as:
very quiet
fairly quiet
social
I am most comfortable:
with large groups of people
What types of music do you enjoy:
Alternative
Classic Rock
Country
Jazz/R&B
Dance/Hip Hop/Rap
Pop/Top 40
Hard Rock/Metal
Classical
Student Clubs
Christian Fellowship
Residential Life
Auto Clubs
Club & Rec. Sports
Athletics - what sport?
Military - Active
Military - Non Active
with a few close friends
very social
alone in my room
I am interested in participating in the following activities:
Student Signature: Date:
PLEASE RETURN TO:
The University of Northwestern Ohio
Attn: New Student Services
1441 N. Cable Road
Lima, OH 45805
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