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Housing Application
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First Name
*
Middle Initial
Last Name
*
Student ID Number
*
Date of Birth
*
Month
January
February
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Day
1
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31
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Gender
*
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E-mail Address
*
Home Phone Number (555)555-5555
*
Cell Phone Number (555)555-5555
*
Address 1
*
Address 2
City
*
State
*
Alabama
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Virginia
Washington
West Virginia
Wisconsin
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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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