INSTRUCTIONS
Please provide the information below as completely
and accurately as possible to indicate your desire to live
on campus during the 2011-2012 academic year.
You will be notified of your housing assignment during the
summer, when you will be informed of your hall and room, along
with contact information for your future roommate.
If you have any questions, please contact the Office of Student Life at x7221.
* REQUIRED
FIELDS
PERSONAL
INFORMATION
Last Name: *
First Name: *
Middle Name:
Preferred Name (nickname):
Home Street:
Home City:
Home State:
Home Zip Code:
Birth Date: *
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
Email Address: *
Home Phone: *
(
)
-
Cell Phone:
(
)
-
AOL Instant Messenger Screen Name:
The best way to contact me over the summer is: *
Please indicate the statement that best describes
your situation:
I am a new first year student (never attended MBC or any other college, coming with less than 27 credit hours)
I am a new transfer student (have attended college elsewhere previously and am transferring more than 27 credit hours to MBC)
I am a returning MBC student (have previously attended MBC)
HOUSING
PREFERENCES
The Office of Residence
Life seeks to provide special housing accommodations for
students with medical needs where possible. In order to
request consideration for a health related accommodation (physiological or psychological) you
must submit documentation by a health care provider
(i.e. physician, licensed psychologist, or psychiatrist) stating
the need for accommodation (i.e. air conditioned room, single
room, etc.). Requests are reviewed on a case by
case basis and evaluated in conjunction with the MBC Health
Center professionals. Every reasonable effort will be made
to accommodate documented needs but we do not guarantee that
every request will be met.
More information for special housing accommodations can
be found on the On
Campus Housing Medical Exception Form (MS Word).
Check here if you are requesting
special accommodations (include link that provides additional
information - perhaps include a form or fax number)
Please
briefly describe your needs:
Smoking in the residential living areas is not allowed at MBC.
Do you consider yourself a smoker? *
Yes, I smoke
No, I don't smoke
Are you open to living with a smoker? *
Definitely
No Preference
Definitely Not
Do you have a roommate you would like to request? *
Yes
No
Roommate's Name:
Roommates
must be mutually requested
MORE
ABOUT YOU
What is your opinion of the opposite gender guests
staying in your room overnight? *
Please choose ...
Okay
I don't care either way
No overnight guest
What is your opinion of the same
gender guests staying in your room overnight? *
Please choose ...
Okay
I don't care either
way
No overnight guest
Describe a comfortable flow of visitors in the
room: *
Please choose ...
Frequent, the more the merrier
Periodic, visitors are fine, just not all the time
Infrequent, prefer not to be disturbed
I consider myself to be: *
An introvert, quiet, shy, prefer to keep feelings
to yourself
An extrovert, outgoing, gregarious, prefer to socialize
Equally extroverted and introverted
I consider myself to be: *
Religious
Spiritual
Neither
What time do you get up in the morning? *
Please choose ...
Between 6-8am
Between 8-10am
After 10am
Varies from day to day
What time do you go to bed? *
Please choose ...
Before 10pm
Between 10pm and
midnight
After midnight
Which statement describes your bedroom at home? *
Please choose ...
Things are organized
It is occasionally
clean
It looks like a
tornado hit
I usually prefer to study *
Please choose ...
In the library
or study lounge
In my room quietly
In my room with
music or TV
Please rank the following statements from 1-4 with
1 being the most important to 4 being the least important.
I came to college to ...
1
2
3
4
study and get good grades so that I can get a good job after
graduation.
1
2
3
4
learn about myself and others.
1
2
3
4
get involved in the campus and make a difference.
1
2
3
4
have fun and expand my social life.
Would you be willing to live with an international
student?
Yes
No
Please describe any hobbies , special interests,
particular likes or dislikes, or any information that will
be helpful in determining an appropriate roommate.
Please give three adjectives that best describe
you.
Please describe in a few sentences what you are
looking for in a roommate.
In selecting /accepting a room, I agree to
abide by the rules and regulations of my residence hall
and of Mary Baldwin College. I realize that if at any
time my room is not filled to capacity, a student(s)
may be assigned to fill it. I realize, I may not move
out or have another student move into my room without
first receiving permission from the Office of Residence
Life. I understand that Mary Baldwin College has the
right to remove me from housing if my conduct is dangerous
to me or to other members of Mary Baldwin College community.
I understand that specific housing placement cannot be
guaranteed. I authorize the College to provide my name,
address, email address and phone number to my new roommate
unless I notify, in writing, the Office of Residence
Life otherwise.