Lewis & Clark College Office of Campus Living P 503.768.7123 F 503.768.7977 E living@lclark.edu If you not have a roommate at the time of your application to the campus apartments or during room selection for the residence halls, you are required to complete this form so that the Campus Living staff have adequate information about you to assign a compatible roommate The absence of this form does not mean a roommate will not be assigned to you Please return this form with your Lease Agreement/Housing Contract ROOMMATE PLACEMENT QUESTIONNAIRE FOR RETURNING STUDENTS Name: Preferred First Name: Gender: Pronouns: Major: Phone: Email: Room Preference I am applying for an Apartment Residence Hall Contract/Lease Length: Academic Year Fall Spring If you marked partial year, please indicate which overseas/domestic program you will participate in or note other reasons for a partial year: I prefer this room type: Double Single Apartment Please mark all that apply but understand this does not guarantee availability If you are applying for a campus apartment, did you also complete a housing contract in the event an apartment is unavailable? Yes No Diversity & Inclusion Campus Living is committed to creating a supportive, interdependent, and educationally purposeful residential community for Lewis & Clark College To that end we celebrate the diversity of our campus population and seek to provide safe, inclusive, supportive, and positive residential experiences for ALL of our students The following questions are designed to help us place students in an environment that allows them to be their most authentic selves Would you be interested in living with an International student? Yes No Campus Living seeks to provide a safe and supportive environment for LGBTQIA+ students and looks to place them with other students who are allies Gender inclusive is defined as being open to all persons of all gender identities and/or gender expression An ally is defined as a person who is supportive of members of the LGBTQIA+ community If you are unsure of what LGBTQIA+ stands for, please click here Do you identify as LGBTQIA+? Yes No I choose not to answer Would you be able to be an ally of a roommate who identifies as an LGBTQIA+ student? Please indicate the gender identity/ies of people you would be comfortable living with: Yes No Male Female Are you interested in actively pursuing Gender Inclusive Housing (rooming with a person regardless of their gender)? If yes, Campus Living staff may initiate a follow up conversation with you Would you be comfortable living with a roommate who has a service/assistance animal? Yes No Yes No Details: Do you have any documented allergies that may prevent you from living with a service/assistance animal? Yes No Personal Information and Preferences On questions with multiple choice boxes, please mark all that apply About Me: Possible field of study/major & other intellectual interests: What extracurricular activities or other activities you for fun & relaxation? My musical preferences are: Instruments played: I consider myself: Shy Classical Mellow Rock Talkative Alternative Outgoing I require: Very little private time Some private time A significant amount of social time Country Introvert Rap R&B Extrovert Jazz Other: Other: A significant amount of private time Very little social time Some social time Although Lewis & Clark is a smoke and tobacco-free community, smoking habits off-campus are an important factor on which we match roommates Are you a smoker? Yes Occasionally No Are you comfortable with a roommate that is a smoker? Yes No Room Care and Use: I want my room to be: Quiet and study oriented Mark all that apply: guests A social gathering place for friends to hang out I am okay with overnight guests with 12 hr notice I am okay with platonic overnight guests I plan to spend: Most of my time in my room Most of my time outside of my room room and half of my time out of the room Unsure I would describe my room as: Always clean and organized My ideal room temperature is: Below 65°F/18°C Sleep Habits: I go to bed: Before midnight I get up: Before 8AM I consider myself a: Around Midnight 8AM-10AM Light Sleeper When I sleep I (check all that apply): Study Habits: I expect to study: I plan to study: When I study: Heavy Sleeper Snore 65°F/18°C - 70°F/21°C 10AM-12PM Outside my room In the morning In the afternoon Cluttered I prefer no overnight Half of my time in my Disaster Area 70°F/21°C - 75°F/24°C Above 75°F/24°C Usually right at 12PM or later Usually right at Other: Sleepwalk In my room No time in my room Fairly neat and clean After Midnight A combination of social and quiet Sleep Talk Windows Open Windows Closed Music On Music Off Both inside and outside my room In the evening I like to have music or other background noise Late at night I need total quiet I don’t have a preference Roommate Qualities: What qualities are you looking for in a roommate? _ What qualities would you find difficult to tolerate in a roommate? Is there any additional information you would like us to consider when matching you with a roommate/s or about the sections above?