Office of Admission Housing Application

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Housing Semester Applied For	of Year
Gender
Birthdate
Age
Name (First, Last)
Present Address
City
State
Zip Code
Country (if not USA)
Email Address
Phone	(Include area code)

Permanent Address
City
State
Zip Code
Country (if not USA)
Phone

Personal Information In case of an emergency, the University may contact the following person:
Name (First, Last)
Address
City
State
Zip Code
Phone

Student Classification (check one)	Freshman Sophmore Junior Senior Graduate
Housing Application Status	New Student Transfer Returning UD Student
University of Dubuque residence halls are according to the Student Handbook smoke free and alcohol free environments.
Residence Hall Preference (Check One Below). Room and roommate assignments are made through the University Housing Office. Aitchison Hall is a men's and women's residence hall located on UD's main campus. It has single, double and triple occupancy rooms. Cassat Hall is a women's residence hall located one block from the main campus next to Donnell Hall. It has double occupancy rooms only. Donnell Hall is a men's residence hall located one block from the main campus next to Cassat Hall. It has double occupancy rooms only. No Preference
If availbale, would you prefer a quiet floor? Yes No No Preference
Do you smoke? Yes No Do you object to a roommate who smokes? Yes No
Are there any health concerns, limitations, allergies, special accomodations or continuing medication needs you feel should be taken into account when assigning you a room Yes No If Yes, please specify
The University of Dubuque has a large multi-cultural program and encourages students to consider living with a student from another country. To take advantage of this unique opportunity, please check the appropriate box. Yes, I am interested in living with an international student. No, not at this time. No Preference
Please list your academic major or interests:
Please list any extracurricular activities in which you participate:
Please list the varsity sports in which you plan to participate:
Please list some of your hobbies:
What style of music do you prefer?
What is your religious preference?
If you would like to request a roommate, please do so here: (We cannot guarantee that your request will be granted, but we will try to honor your request.)
Please respond to the following statements by checking the box to the right of each statement that is most characteristic of you. Remember that your responses to these questions will help us in selecting your roommate.
	Never	Rarely	Sometimes	Frequently	Always
I get up early (before 8:00 a.m.).

I go to bed late (after 11:00 p.m.).

I keep my room neat and clean.

I am comfortable with other people using my belongings.

I like to study in absolute silence.

I like to play my stereo loud.

I am comfortable in large groups of people.

I plan to participate in church-related activities.

I like to exercise on a regular basis.

I want my roommate to be one of my best friends.

I like to have people over to my room.

I am comfortable expressing my feelings.

I plan to go home on weekends.

I follow a schedule regularly.

IMPORTANT After having read this application, I understand the above guidelines as stated and realize that upon check-in to the hall I will be required to sign a one academic year housing agreement. We cannot process your application without your verification below. I have verified the information Date