Jefferson Community College
East Hall
Student Housing Application

1. 
2.  55-0357
3. The Office of Residence Life & Hous
ing775 Rand Drive,  
Applicant Information
Legal  (First, Last, M.I.)
Preferred Name:
 


 



 Student Status



 Current housing status



 What is your intended academic major _______________________________________
 Have you ever been convicted of a felony?


5Select the term for which you are applying for residence
20 
20 
2021 
9

6If you plan to play intercollegiate sports please indicate which sport(s)







7Please indicate your room preference




8Please indicate your first and second preferences




 Please select a meal plan



 

 Do you require any special accommodations that would affect your room housing
assignment or meal plan?


Coordinator of Student Accommodations and Testing Services 







1 Do you have any known allergies?


9

1 If you have a particular person you want to room with type or write their name
here(NOTE Roommate requests must be mutual)





. Describe your ideal roommate relationship



How do you feel about your roommate using your belongings?




Describe how clean you prefer your room to be



 When does your average day begin?



 When do you go to sleep on average?



 How would you describe your sleeping habits?



9

 Please check the three () types of music that you listen to and enjoy the most
  
  
  
  
  
  
  
 Please check the three () ways you most enjoy spending extra time
  
  
  
  
  
  
2 Describe your personality


2 Describe your preferred roommate personality


How social do you prefer your room to be?



 How do you study?




. How would you prefer your roommate respond if heshe were angryfrustrated with you?




 How would you respond if you were angryfrustrated with your roommate?




9

Do you smoke?


 Do you prefer that your roommate is a nonsmoker?


 Do you drink?


Do you prefer that your roommate does not consume alcohol


3 Generally rooms are assigned to students of the same gender Jefferson Community
College affirmatively supports the 1esbian Gay Bisexual Transgender and Ally (1GBTA)
community Gender inclusive rooms may be available where students regardless of sex gender
or gender identify share the same bedroom All East Hall suites have private singleuse
bathrooms Are you interested in a genderinclusive room assignment?



3 Please provide any other important information that should be taken into consideration
when placing you in the residence halls None of the information taken in this survey will be
shared outside of the Office of Housing & Residence 1ife
Questions? The Residence 1ife Handbook
had many answers to your questions You may also
contact the Office of Housing & Residence 1ife at reslife@sunyjeffersonedu or 
9
