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Housing Contract
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Fields marked with an * are required
Personal Information
Email Address *
First Name *
Middle Name
Last Name *
Birthdate *
Birthdate *
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Cell Phone *
Mailing Address *
Mailing Address *
Country
Street
City
Region
Postal Code
Housing Information
Assignment Period *
Fall Semester 2022
Spring Semester 2023
Resident Status *
New Student
New Transfer Student
Returning To Clarke
Graduate Student
Room plans may be viewed online
HERE
.
Preferred Room Type *
Double
Single
Apartment
Meal Plan Selection *
19 meals per week
14 meals per week
10 meals per week
75 meals per semester (CDA, MJH Letterwing only)
Meal plans may be viewed online
HERE
.
19 meals per week is eating 3 meals a day.
14 meals per week is eating 2-3 meals a day.
10 meals per week is eating 2 meals a day.
75 meals per semester (Apartment / Commuter meal plan)
Are there special accommodations, health concerns, allergies, or limitations? Please explain
Residence Life will recognize and respect the gender identity that students self-identify. Students may contact the Residence Life office if they wish to receive special housing considerations regarding their gender identity.
Gender *
Roommate Preference Questionnaire
Smoking *
I am a smoker
I am a non-smoker, and prefer a non-smoking roommate
I am a non-smoker, and do not mind a roommate who smokes
Cleanliness *
I am very neat and organized
I like things to look "lived in" – not too messy, not ultra neat
I am messy – sometimes it is hard to see the floor
Room Environment *
I like quiet and I am easily distracted
I like background noise/music
I am able to tune out noises and am not easily distracted
What are your favorite interests and activities?
What type of music do you listen to?
Personal Hours *
I am an early-to-bed, early-to-rise type of person
I stay up late and like to sleep in to compensate
I am flexible
I plan to go home *
on designated holidays/breaks
1-2 weekends a semester
1-2 weekends a month
3-4 weekends a month
Socializing in the halls *
I enjoy people dropping by
I will invite people over but need time alone
I want my room to be the hangout room
Roommate relationship *
I want and hope that my roommate becomes one of my good friends
I want that we (and hope to) hang out sometimes and get dinner once in a while
I want to be cordial and get along well in the room, but don’t necessarily need to be good friends
I want to be able to respect each other’s time and space, but don’t expect anything beyond that
If you have a preference of a roommate, please list here Both persons must request each other.
Is there anything else you would like us to know as we determine room assignments and roommate pairings?
Signature
Room and Meal plan prices may be viewed online
HERE
.
Residence Hall Contract Terms and Conditions
Terms and Conditions *
Terms and Conditions *
I verify I have read and understand the above terms and conditions and I am agreeing to them. *
This form, when submitted with appropriate electronic signature(s), is a request to rent Clarke University residence hall space.
Resident Signature *
Date*
Parent or Guardian Signature (If resident is under 18 years of age)
Date
Submit