Section One - Student Information

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First Name

Last Name

Gender

Address

May we share your e-mail address with a prospective roommate?

Program of Study

Potential Roommate’s Name * (optional)
*requests will be honored if space allows and if both roommates list the same preference.

If space is available, would you be interested in a single occupancy room?

Smoking Preference
(Although smoking is not permitted in college housing, this habit can still affect living accommodations and roommates.)

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