1. I usually go to bed between the hours of ______                   9. In regard to my personal property, I prefer
   and ______.                                                           to share everything.
                                                                         to let my roommate use specific items without permission.
2. I usually wake up between the hours of ______ and ______.                List:__________________________________________
                                                                         to let my roommate use items after asking for my permission.
3. I sleep best when the room is…                                        not to share anything.
   Things to consider:
   Noise level                                                       10. If someone wants to borrow my property, I would prefer that
   Temperature                                                           my roommate…
   Light & Darkness                                                       lend it to the person.
                                                                          lend it only if I gave prior permission to that specific person.
4. I would like to have private time in the room…                         never lend out anything of mine.
   Discuss the need to give each other space and when it might be
   important.                                                        Note: Be sure to discuss food, clothes/toiletries & appliances.

5. The time of day I prefer to study is…                             11. In regard to my computer, printer, and other personal
   Discuss what ideal study situations and environments are and          electronic devices (i.e., iPods, cell phones, CD players, etc., I
   how to respect them.                                                  prefer:.
                                                                          to share everything.
6. The atmosphere best conducive for my studying is                       to let my roommate use specific items without permission.
    in complete silence.                                                    List:__________________________________________
    with the stereo or TV on.                                            to let my roommate use items after asking for my permission.
    alone.                                                               to not share anything.
    with others.                                                    Note: Be sure to discuss returning items, logging out of computers,
    outside of the room.                                            and potential access to personal information on these devices.

7. Regarding appearance of the room, I prefer that it be             12. In regards to using the computer(s)
    usually orderly and clean.
    sometimes orderly and clean.                                    13. I would prefer that guests
    disorderly (i.e. no preference).                                     be welcome anytime.
                                                                          leave when I sleep.
8. When cleaning the room, I feel that                                    leave when I sleep, unless I give prior consent to stay.
    my roommate and I should take turns cleaning the entire room.        leave when I am in the room.
    my roommate and I should each clean up our own mess.
    my roommate and I should clean the room together.               14. I believe that guests
                                                                          should not be left alone in the room.
                                                                          can be left in the room without me or my roommate present.
15. For safety and security reason, I would prefer that the room
     be locked at all times.
     be locked when we are not in the room.
     be locked only when we are not in the room.
                                                                       Roommate Survey
     be locked when I go to bed or am asleep.
                                                                             To be discussed and defined on a forthcoming
16. When I am upset, I need…                                                            Roommate Agreement
     to talk about things.
     space and time to deal with it on my own.
     space unless the feelings are directed toward my roommate.

17. If I were going to be gone for a weekend or longer, I would
     want my roommate to know where I am.
     let my roommate know when I will return.
     want my roommate to know where I am and let my roommate
         know when I would return.
     prefer not to let my roommate know my whereabouts.

18. When I receive mail, I would prefer that my roommate
     leave it in the mailbox for me to pick up.
     bring the mail to the room if s/he checks the box first, (and
      leave it__________________ ).

19. When I am not present to receive a telephone call, I would
    prefer my roommate to
     look for me on the floor.
     write down a message for me (and leave it _____________ ).
     give my cell phone number to the caller
     simply tell the caller I am not home and to call back later.                             INSTRUCTIONS
20. I will hold my roommate and myself accountable to this            Please read the twenty questions and consider the options you prefer.
    agreement by                                                      Be prepared to discuss your preferences with your roommate for the
     confronting the situation on my own.                                                   Roommate Agreement.
     confronting the situation with the help of my RA.
                                                                                         Consider multiple options where applicable.
                       Additional Comments

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