Fuse Roommate Matching

Office Only

Roommate Matching

q Roommate Requested

Apt #:

Room #:

Date Lease Signed:

Full Name: __________________________________________________________________ Birth date: __________

Gender Identity: ______________ Gender you would like to live with:

Male

Female

No Preference

Current Phone: __________________________________ Email Address: __________________________________

College Attending: Purdue

Not Attending College

Major/Minor: __________________________________ Classification when lease term begins: Fresh Soph Jr Sr Grad Non-Student

Preferred study location: Library My bedroom

Apartment living room Other: ___________________________

How would you estimate your study hours?

0-10 hrs a week

10-20 hours a week

21 plus hours a week

Preferred study environment: q Loud Music/TV

q Soft Music/TV

q Silence

q Other: ________________

What is your ideal apartment atmosphere? q Quiet, study-oriented

q Focused weekdays, social weekends q Highly social

Describe your housekeeping habits:

Very neat

Depends on my schedule

Not a priority

How often would you like your shared common areas cleaned?

More than 4x a week

2-3x a week

Once a week

Regarding sharing my belongings: Willing to share anything

Willing to share, but please ask first

Not into sharing at all

Are you a smoker? Yes No

Would you mind living with a smoker? Yes No

How often do you drink alcohol? More than 4x a week 2-3x a week Once a week Rarely Not at all

You usually wake up:

Early all the time

Late all the time

Depends on my schedule

You usually go to bed:

Early all the time

Late all the time

Depends on my schedule

How often do you plan on having guests over?

Frequently

Sometimes

Rarely

If your roommates want guests over: I love meeting new people

That’s fine, but please ask first

I prefer my privacy

Do you plan on having overnight guests? q Yes

q No

Do you mind if your roommate has overnight guests? q Yes

q No

What extracurricular activities are you involved in? _________________________________________________________________

Are you in a sorority/fraternity? Yes No

If yes, which house? _______________________________________________

Are you a student athlete? Yes No

If yes, which sport? ___________________________________________________

Do you have a job?

Yes No If yes, where? ____________________________ What are your hours? _____________________

plan  

Do you plan to find a job?

Yes No

How many hours per week do you

t o work? ____________________________

Type(s) of music you listen to: _______________________ Type(s) of music can you not tolerate: __________________________

Hobbies/Interests: ___________________________________________________________________________________________

List any other preferences you feel we should know when matching you with your prospective roommate(s):

Roommate preference(s):

By submitting this questionnaire, I am hereby requesting that my landlord try to find additional tenants with which I will share my apartment. I acknowledge that my

landlord is providing this service to me for my benefit and may not be able to locate such individuals. I further acknowledge that my although the landlord has conducted a

background check on all prospective residents as part of its screening process, that information will not be shared with potential roommate candidates. I do hereby release,

agree to indemnify, defend and hold harmless, my landlord and its affiliated entities from any and all liability associated with the process of roommate matching.

Resident Signature: _______________________________________________ Date:

45815937.2