Miramar College Resident Profile
                                     Office of Housing and Residence Life

 Name __________________________________________                Arriving for which term: (circle one)
         Last/Family            First/Given       Middle        Fall    Spring     Summer             __________ Year

 Student ID Number_______________________________               Major/Program: ___________________________________

 Social Security Number____________________________
                                                                Gender:                   Birth Date: ____/____/____
 Mailing Address__________________________________               Female                               (Month/Day/Year)
                                                                 Male

 Phone Number __________________________________

                                                                    I have lived at Alliant before.
 E-mail _________________________________________
  Please check if you prefer to be contacted via e-mail

Please check box if you want a private room □
There are a limited number of private bedrooms and it is more expensive than a double room. You can request a single
room by signing here: _____________________

By initialing here you have read this everything in this box and are aware that you are asking for a private room _______

In the event of an emergency, we should contact:
                                                               Please list any special health issues, concerns, and/or physical
Name ______________________________________                    needs that may affect your room assignment or housing
Relationship to Student ________________________               _______________________________________________

Phone Number _______________________________                   _______________________________________________

Roommate/Suitemate Preferences: (Please circle ONE ONLY for each question.)

           a)   Undergraduate                 Graduate

           b)   Smokes                        Doesn’t smoke         Don’t care

           c)   Quiet                         Not Quiet             Don’t care

About You (Please circle ONE ONLY for each question.)

           a)   Smoke                         Don’t Smoke

           b)   Undergraduate                 Graduate

                                                            OVER (2nd page)
                Require any special living accommodations (Check as many that apply to you):

                Wheelchair accessibility_____
                Guide dog or other assistance animal?_____
                Personal Aid_____

                (Please check ONE ONLY for each question.)

                Room neatness: __ I am very tidy and organized
                               __ I am semi-tidy
                               __ I am not tidy and leave things everywhere

                Study habits:      __ I need absolute quiet as I am easily distracted by noise
                                   __ I am able to tune out most noises and I am not easily distracted

                Room/Suitemate: __ I would prefer a roommate from a specific country
                             What country?___________________________________________________

                                Name(s) of resident(s) I would like to live with: _________________________________

                What are your interests\hobbies?____________________________________

                What type of music do you like?_____________________________________

                Other: Please share any additional information about yourself that you think will assist in room/suitemate
                placement: _____________________________________________________________________________

   I give permission for the Office of Housing & Residence Life to provide my roommates/suitemates with
    my home address, e-mail and phone number. If this box is not checked, we will not give your

Preferences are not guaranteed. Suite and roommate requests are based on housing availability, contract information, and
management concerns.

You must sign the Miramar College Residential Living License Agreement and submit a $265 room reservation deposit in
order for us to process your housing application.

This housing form is intended to be advisory in nature and the University assumes no responsibility or liability in its use.

Signature ___________________________________________________ Date ___________________________________

To complete your housing registration remember to send to following items

                Residential Living License Agreement
                $265 room reservation deposit
                Consent to release information form

If you have any further questions, please contact the Office of Housing & Residence at
        Consent to Release Information Form
This Authorizes:
                          Alliant International University
                          10455 Pomerado Road
                          San Diego, CA 92131

And                       Miramar College
                          10440 Black Mountain Road
                          San Diego, CA 92126

To exchange information pertaining to:

Student Information
                    Name (Last, First, and Middle Initial)        Social Security

                    Alliant Student ID #                          Miramar
Student ID #

Permanent Address
                   Street Address                                Apt/ PO Box

                     City                      State               Postal Code


As a condition of living in Alliant International University’s residence halls as a Miramar College
student, you must consent to the sharing of information between both institutions. Failure to
complete this agreement will terminate the Alliant Residential Living License Agreement. This
consent form is valid throughout your stay in Alliant’s residence halls and while attending
Miramar College. Should you no longer be a full-time student (12 credits per semester or more)
at Miramar College, you will no longer be able to reside on campus at Alliant International
University and will need to make other housing arrangements.

Authorizing Signatures:

_____________________________________                        ____________________
Student                                                      Date

_____________________________________                        ____________________
Witness                                                      Date

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