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First Name
*
Middle Initial
Last Name
*
Student ID Number
*
Date of Birth
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
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1972
1971
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1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
Choice 55
Gender
*
Male
Female
E-mail Address
*
Home Phone Number (555)555-5555
*
Cell Phone Number (555)555-5555
*
Address 1
*
Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP or Postal Code
*
Emergency Contact Information
I will provide emergency contact information. (Complete the form below)
I decline the option to provide emergency contact information
Roommate Preference and Compatibility
Please respond to the following as truthfully as possible as these questions will be used to match you with a roommate. In order for successful matching, please answer as they relate to you, not what you are looking for in a roommate. You should not expect to have similar responses on all of these questions. It is important for roommates to discuss their likes and dislikes as a means to better understand each other and to build a cooperative relationship. PLEASE NOTE: as with the rest of the application, it is very important that the profile questions are completed by the student, not a parent or guardian.
Do you have a roommate preference?
Yes
No
Would you prefer a roommate with the same major?
Yes
No
Do you smoke?
Yes
No
I got to bed...
9PM or earlier
10 PM
11 PM
12 AM
1 AM or later
I wake up...
7 AM or earlier
8 AM
9 AM
10 AM
11 AM or later
Do you tend to be
Outgoing
Shy
Do you prefer your music
Loud
Quiet
Do you keep your room
--
Neat
Somewhat neat
Somewhat messy
Messy
Study Habits
1-3 Hours a day
3+ Hours a day
In library
In room
In silence
With music
(Check all that apply)
Would you prefer a coed floor?
Yes
No
No preference
Where would you prefer to live?
Matthews
JDC
No preference
Have you ever been convicted of a felony?
*
Yes
No
Are you a UM Western athlete?
Yes
No
Have you decided on a major?
Yes
No
Do you have any special accommodation needs?
Yes
No
Term when I move in
*
Fall 2018
PIMA 2018
Spring 2019
PIMA Vet Tech 2019
PIMA Vet Asst 2019
Are you planning on staying the entire semester?
*
Yes
No
Please check one:
*
New Student
Transfer Student
Continuing Student
When I move I will be...
*
Freshman (0-30 credits)
Sophomore (31-59 credits)
Upper Class (61+ credits)
Resident Contract
Carefully read the Housing Contract Conditions and Montana Western Student Handbook, click links for a downloadable pdf. Note that all resident students are obligated to live in on-campus housing and participate in the meal plan offered by Montana Western. Current costs for room rental, meal plan, and other fees are listed on our website.
I agree to abide by the terms and conditions of the housing contract and the Montana Western student code of conduct.
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