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Questionnaire for incoming Amherst freshman

New Student Housing Questionnaire

Think carefully about your responses, as they will effect where you are placed. Your responses to the questions will be considered in relation to each other as we make your housing selection. Assignments will be made primarily on the compatibility of personal living habits and interests based on your answers to the questions below. It is very important that you answer all these questions honestly to assist us in selecting a roommate for you. Keep in mind that most new students are assigned to a one-room double with a roommate.

You First Name: *

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Last (Family) Name: *

1. Academic Interest

Please check your primary area of academic interest.

Academic Interest:

Math/Sciences

Social Sciences

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Humanities

Theater/Art

Other

Other academic:

If other, please enter.

2. Sports

Do you plan to play a sport while at Amherst (varsity or club)? Please indicate your primary and secondary varsity and club sports, if any.

Secondary varsity sport:

Primary varsity sport:

Primary club sport:

Secondary club sport:

3. Extracurricular

What extra-curricular activity are you most interested in?

EC:

Music/dance

Outdoor activities

Newspaper/campus publications

Student government

Other

Other EC:

If your activity is not listed, please enter it here.

4. Smoking

Do you smoke? Note: Smoking in all dorms is prohibited, both in common areas and dorm rooms.

Smoking:

no

yes

5. Subfree

Do you wish to live on a substance-free floor (no alcohol or other drugs)?

Note: Substance free floors are floors whereby students make a commitment not to indulge in destructive behaviors and to work with the RC to promote a healthy lifestyle. More info will be discussed at the first floor meeting.

Subfree:

no

yes

no preference

“No preference” means you could be placed on a substance-free floor.

6. Bedtime

During the week, I tend to go to bed:

Bedtime:

before midnight

after midnight

7. Uptime

During the week, I tend to wake up:

Uptime:

before 8 a.m.

after 8 a.m.

8. Sleeping

I am a . . .

Sleeping:

heavy sleeper

light sleeper

9. Roommate sleep

Do you object to a roommate whose sleeping habits are different from yours?

Roommate sleep:

no

yes

10. Neatness

My room tends to be:

Neatness:

messy

neat

11. Roommate’s music

Do you object to your roommate playing music while you study?

Note: We encourage students to bring headphones.

Roommate’s music:

no

yes

12. Single-sex floor

Do you want to live on a single-sex floor?

Note: All of the buildings are co-ed by floor; however, if needed, space within a first year dorm will be designated for both single-sex female and a single-sex male.

Single-sex floor:

no

yes

13. International cultures

Are you interested in international cultures? If so, which ones?

International cultures:

14. Comments

Please include any additional comments or information to help us with your housing arrangements. Note: Many of you may not have had the opportunity to visit our first-year residences -- while their architecture differs somewhat, all have been renovated or completely rebuilt within the last several years, and offer similar accommodations. All of our first-year residences have elevators, single-sex bathrooms, internet access, and study lounges. Keep in mind that nearly all rooms in first-year housing are one-room doubles so you will most likely have a roommate.

Comments:

15. Medical

Are special rooming arrangements advisable for you because of health problems? If so, please explain below and have a physician’s statement sent to the Dean of Students Office. Note that subsequent years after your freshman year, there is a separate process to complete to determine continued needs for Special Housing.

Medical:

16. Contact

Please provide a phone number and e-mail address we can use to contact you over the summer if we have questions about any information provided on this form.

Phone:

Telephone number: please enter in a full 10 digit number without (), -, or .

Email:

Please enter your email address. 17. Roommate permission

17. Roommate permission

Do you give permission for us to provide your phone number or e-mail address to your roommate(s) over the summer?

Roommate permission:

no

yes

18. Cell Phone

Cell Phone Number: please enter in a full 10 digit number without (), -, or .

Cell phone:

19. Directory permission

Students have the option of publishing their cell phone numbers in the campus paper directory. Would you like this number published?

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