"Roommate Matching Template - Fuse"

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Office Only
Roommate Matching
q Roommate Requested
Apt #:
Room #:
Date Lease Signed:
Full Name: __________________________________________________________________ Birth date: __________
Gender Identity: ______________ Gender you would like to live with:
Male
Female
No Preference
Current Phone: __________________________________ Email Address: __________________________________
College Attending: Purdue
Not Attending College
Major/Minor: __________________________________ Classification when lease term begins: Fresh Soph Jr Sr Grad Non-Student
Preferred study location: Library My bedroom
Apartment living room Other: ___________________________
How would you estimate your study hours?
0-10 hrs a week
10-20 hours a week
21 plus hours a week
Preferred study environment: q Loud Music/TV
q Soft Music/TV
q Silence
q Other: ________________
What is your ideal apartment atmosphere? q Quiet, study-oriented
q Focused weekdays, social weekends q Highly social
Describe your housekeeping habits:
Very neat
Depends on my schedule
Not a priority
How often would you like your shared common areas cleaned?
More than 4x a week
2-3x a week
Once a week
Regarding sharing my belongings: Willing to share anything
Willing to share, but please ask first
Not into sharing at all
Are you a smoker? Yes No
Would you mind living with a smoker? Yes No
How often do you drink alcohol? More than 4x a week 2-3x a week Once a week Rarely Not at all
You usually wake up:
Early all the time
Late all the time
Depends on my schedule
You usually go to bed:
Early all the time
Late all the time
Depends on my schedule
How often do you plan on having guests over?
Frequently
Sometimes
Rarely
If your roommates want guests over: I love meeting new people
That’s fine, but please ask first
I prefer my privacy
Do you plan on having overnight guests? q Yes
q No
Do you mind if your roommate has overnight guests? q Yes
q No
What extracurricular activities are you involved in? _________________________________________________________________
Are you in a sorority/fraternity? Yes No
If yes, which house? _______________________________________________
Are you a student athlete? Yes No
If yes, which sport? ___________________________________________________
Do you have a job?
Yes No If yes, where? ____________________________ What are your hours? _____________________
plan  
Do you plan to find a job?
Yes No
How many hours per week do you
t o work? ____________________________
Type(s) of music you listen to: _______________________ Type(s) of music can you not tolerate: __________________________
Hobbies/Interests: ___________________________________________________________________________________________
List any other preferences you feel we should know when matching you with your prospective roommate(s):
Roommate preference(s):
By submitting this questionnaire, I am hereby requesting that my landlord try to find additional tenants with which I will share my apartment. I acknowledge that my
landlord is providing this service to me for my benefit and may not be able to locate such individuals. I further acknowledge that my although the landlord has conducted a
background check on all prospective residents as part of its screening process, that information will not be shared with potential roommate candidates. I do hereby release,
agree to indemnify, defend and hold harmless, my landlord and its affiliated entities from any and all liability associated with the process of roommate matching.
Resident Signature: _______________________________________________ Date:
45815937.2
Office Only
Roommate Matching
q Roommate Requested
Apt #:
Room #:
Date Lease Signed:
Full Name: __________________________________________________________________ Birth date: __________
Gender Identity: ______________ Gender you would like to live with:
Male
Female
No Preference
Current Phone: __________________________________ Email Address: __________________________________
College Attending: Purdue
Not Attending College
Major/Minor: __________________________________ Classification when lease term begins: Fresh Soph Jr Sr Grad Non-Student
Preferred study location: Library My bedroom
Apartment living room Other: ___________________________
How would you estimate your study hours?
0-10 hrs a week
10-20 hours a week
21 plus hours a week
Preferred study environment: q Loud Music/TV
q Soft Music/TV
q Silence
q Other: ________________
What is your ideal apartment atmosphere? q Quiet, study-oriented
q Focused weekdays, social weekends q Highly social
Describe your housekeeping habits:
Very neat
Depends on my schedule
Not a priority
How often would you like your shared common areas cleaned?
More than 4x a week
2-3x a week
Once a week
Regarding sharing my belongings: Willing to share anything
Willing to share, but please ask first
Not into sharing at all
Are you a smoker? Yes No
Would you mind living with a smoker? Yes No
How often do you drink alcohol? More than 4x a week 2-3x a week Once a week Rarely Not at all
You usually wake up:
Early all the time
Late all the time
Depends on my schedule
You usually go to bed:
Early all the time
Late all the time
Depends on my schedule
How often do you plan on having guests over?
Frequently
Sometimes
Rarely
If your roommates want guests over: I love meeting new people
That’s fine, but please ask first
I prefer my privacy
Do you plan on having overnight guests? q Yes
q No
Do you mind if your roommate has overnight guests? q Yes
q No
What extracurricular activities are you involved in? _________________________________________________________________
Are you in a sorority/fraternity? Yes No
If yes, which house? _______________________________________________
Are you a student athlete? Yes No
If yes, which sport? ___________________________________________________
Do you have a job?
Yes No If yes, where? ____________________________ What are your hours? _____________________
plan  
Do you plan to find a job?
Yes No
How many hours per week do you
t o work? ____________________________
Type(s) of music you listen to: _______________________ Type(s) of music can you not tolerate: __________________________
Hobbies/Interests: ___________________________________________________________________________________________
List any other preferences you feel we should know when matching you with your prospective roommate(s):
Roommate preference(s):
By submitting this questionnaire, I am hereby requesting that my landlord try to find additional tenants with which I will share my apartment. I acknowledge that my
landlord is providing this service to me for my benefit and may not be able to locate such individuals. I further acknowledge that my although the landlord has conducted a
background check on all prospective residents as part of its screening process, that information will not be shared with potential roommate candidates. I do hereby release,
agree to indemnify, defend and hold harmless, my landlord and its affiliated entities from any and all liability associated with the process of roommate matching.
Resident Signature: _______________________________________________ Date:
45815937.2
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