HOUSING PREFERENCE FORM - SU Abroad - Syracuse University

HOUSING PREFERENCE FORM
NAME ______________________________________
Male/Female
HOME UNIVERSITY: ________________________
PLEASE INDICATE YOUR PREFERENCES BELOW:
At the Gazzano there are two flats on each floor and four students per flat, placed in
two separate bedrooms.
At Southampton Row the four flats are on the same floor. There are two six person
flats, one five person flat and one four person flat.
1. I prefer living in a flat that is (please note that there will be separate
bedrooms for each gender):
a. ____ single sex
b. ____ co-ed
c. ____ either single sex or co-ed
2. I prefer living in a flat with:
a. ____ my own University students
b. ____ students from other universities/colleges
c. ____ either of the above
3. I prefer a room-mate(s) who
a. ____ keep(s) late hours
b. ____ do(es) not keep late hours
4. I would describe my level of neatness as:
a. ____ high
b. ____ moderate
c. ____ low
5. I am a smoker*
a. ____ yes
b. ____ no
6. Do you have any dietary restrictions or medical issues that might affect your
needs in a flat:
a. ____ yes (please describe): ________________________________
b. ____ no
*PLEASE NOTE THERE IS A NON-SMOKING POLICY IN ALL OUR
HOUSING ACCOMMODATION AND THAT THE PUBLISHED HOUSING
RULES IN THE APARTMENTS MUST BE ADHERED TO.
continued on reverse

7. I specifically request the following roommate(s):
__________________________________________________________________
(all parties must request each other)
8. I specifically do NOT wish to be roomed with:
__________________________________________________________________
9. Please indicate if there is anything else we should know about you that will
aid us in placing you.
__________________________________________________________________
10. Please indicate in order of preference a housing location:
Gazzano
Southampton Row
______
______
11. I am interested in being a student liaison (2 positions available):
____ Yes (if so, please complete the liaison application and e-
mail/send/drop it off at the office with a resume to 106
Walnut Pl., Syracuse, NY 13244, or e-mail it to
gnrich@syr.edu)
____
No
Academic Major and year:
___________________________________________________________
Other Interests:
____________________________________________________________________
Syracuse University does not discriminate on the basis of race, religion, creed, national
origin or sexual preference. Room assignments cannot be changed. Although every
effort will be made to honour individual preferences, this cannot be guaranteed.
10/2012