Name:

MTA Email:

Residence you live in :

Phone Number:

Mailing Address: (On-campus mailing address, or street address if off-campus)


Home Address:

Please answer the following questions as honestly and accurately as possible. The information you provide will better help us to make compatible matches when assigning roommates. Please check all that apply.

Have you ever been a MASSIE roommate before? Yes No
If "Yes," when?

Have you ever been involved with MASSIE Program before? Yes No
If "Yes," when and how?

Why would you like to have a MASSIE student as a roommate?

What year will you be in next year? 1st 2nd 3rd 4th 5th

What is your major? What is your minor?

Do you smoke? Yes No Sometimes

Would you prefer a (non)smoker as a roommate?
Smoker Non-Smoker Doesn't matter

Do you drink? Yes No Sometimes

Would you prefer a (non)drinker as a roommate?
Drinker Non-drinker Doesn't matter

How many hours do you wish to sleep each night
4-5 hours 5-7 hours 7-9 hours more then 9 hours

What time do you usually wake up?
6-7:30am 7:30-9:00am 9:00am or later

Your room is:
always neat somewhat neat somewhat messy always messy

When do you usually study?
mornings afternoons evenings late at night

How many hours/day do you study?
0-1 hours 1-2 hours 2-3 hours 3 or more

Where do you usually study?
in my room in the lounge at the library coffee shop

How do you prefer to study?
by myself with other people with music no noise

How talkative/quiet are you?
very somewhat talkative quiet very quiet

What music do you enjoy?
(hold ctrl key to select multiple items)
Dance House Rap Rock Classical Jazz Alternative Country Metal Pop R&B World

What are some of your extra-curricular interests?
(hold ctrl key to select multiple items)
intramural sports varsity sports clubs/societies volunteer work the Pub/bar house activities cooking chapel/church the gym parties health/fitness sports nature/outdoors fashion/style playing music computer gaming reading dancing TV/movies listening to music

By typing in your name in the box below it is the same as signing the document and acknowledging that all information stated above is correct.