Residence Hall Application

Student Information

First Name

Last Name

Preferred First Name

Gender Identity

Birthdate

Email Address

Parent/Guardian Email (Optional)

Cell Phone Number

Census Information

Current housing status:

Have you ever been convicted of a felony?

Select the term for which you are applying for residence:

Please indicate your room preference:

Please indicate your first and second preferences:

I prefer a 4 person quad

I prefer a 5 person suite

I prefer a 6 person suite

No preference

Please indicate your first and second preferences:

I prefer a 5 person suite

I prefer a 6 person suite

No preference

Please select a meal plan:

Do you require any special accommodations that would affect your room housing assignment or meal plan?

If yes, please contact Coordinator of Student Accommodations and Testing Services Tanya Hoistion, 315-786-2335, or email and provide the necessary paperwork to support the accommodation as soon as possible to expedite room assignments. (No later than six weeks prior to the start of classes.)

You may request to share a room and/or a suite with other resident student(s) as a long as they are also eligible for housing, have paid the $250.00 housing deposit, and completed the Residence Life Application. Although every effort will be made to honor your request, there is no guarantee. We will assign students on the basis of space availability and established policies. Please note that the roommate your are requesting must also request to live with you.

Do you have any known allergies?

If you have a particular person you want to room with, type or write their name here. (NOTE: Roommate requests must be mutual.)

Roommate Name:

Suitemate Name:

Describe your ideal roommate relationship.

Doing everything together

Being friends

Being respectful and peacefully coexisting

How do you feel about your roommate using your belongings?

Never a problem using any of my things

Ok, but only after asking permission

Ok with electronics, but not my personal items

Not Okay. My roommate should not use any of my belongings

Describe how clean you prefer your room to be.

Usually orderly and clean

Sometimes orderly and clean

Disorderly (i.e. no preference)

When does your average day begin?

Before 8AM

Between 8AM and 10AM

After 10AM

When do you go to sleep, on average?

Before 11PM

Between 11PM and 1AM

After 1AM

How would you describe your sleeping habits?

Heavy sleeper (can sleep through noise, lights, etc.)

Light sleeper (require silence and darkness)

In between

Describe your personality:

Reserved

Social

Describe your preferred roommate personality:

Reserved

Social

How social do you prefer your room to be?

Quiet with minimal guests

Welcoming to one or two friends at a time

A lively social center where everyone hangs out

How do you study?

I require absolute silence

I like low background music

I prefer listening to music or watching television

I leave the room

How would you prefer your roommate respond if he/she were angry/frustrated with you?

Talk to me about it right away

Wait to see if the feelings subside

Talk to me about it later, after cooling down

Talk to our RA

How would you respond if you were angry/frustrated with your roommate?

Talk to him/her about it right away

Wait to see if the feelings subside

Talk to him/her about it later, after cooling down

Talk to our RA

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?

Generally, rooms are assigned to students of the same gender. Jefferson Community College affirmatively supports the Lesbian, Gay, Bisexual, Transgender and Ally (LGBTA) community. Gender inclusive rooms may be available where students, regardless of sex, gender or gender identity, share the same bedroom. All East Hall suites have private single-use bathrooms. Are you interested in a gender-inclusive room assignment?

Yes, interested

No, not interested

Maybe, need more information

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 Life.

Questions? The Residence Life Handbook has many answers to your questions You may also contact the Office of Housing & Residence Life at reslife@sunyjefferson.edu or 315-755-0411.

Jefferson Community College Website

Residence Hall Application