form test

First Name *

Middle Initial

Last Name *

Student ID Number *

Date of Birth *

Gender *

Male
Female

E-mail Address *

Home Phone Number (555)555-5555 *

Cell Phone Number (555)555-5555 *

Address 1 *

Address 2

City *

State *

ZIP or Postal Code *

Emergency Contact Information

I will provide emergency contact information. (Complete the form below)
I decline the option to provide emergency contact information

Roommate Preference and Compatibility

Please respond to the following as truthfully as possible as these questions will be used to match you with a roommate. In order for successful matching, please answer as they relate to you, not what you are looking for in a roommate. You should not expect to have similar responses on all of these questions. It is important for roommates to discuss their likes and dislikes as a means to better understand each other and to build a cooperative relationship. PLEASE NOTE: as with the rest of the application, it is very important that the profile questions are completed by the student, not a parent or guardian.

Do you have a roommate preference?

Yes
No

Would you prefer a roommate with the same major?

Yes
No

Do you smoke?

Yes
No

I got to bed...

I wake up...

Do you tend to be

Outgoing
Shy

Do you prefer your music

Loud
Quiet

Do you keep your room

Study Habits

(Check all that apply)

Would you prefer a coed floor?

Yes
No
No preference

Where would you prefer to live?

Matthews
JDC
No preference

Have you ever been convicted of a felony? *

Yes
No

Are you a UM Western athlete?

Yes
No

Have you decided on a major?

Yes
No

Do you have any special accommodation needs?

Yes
No

Term when I move in *

Are you planning on staying the entire semester? *

Yes
No

Please check one: *

New Student
Transfer Student
Continuing Student

When I move I will be... *

Freshman (0-30 credits)
Sophomore (31-59 credits)
Upper Class (61+ credits)

Resident Contract

Carefully read the Housing Contract Conditions and Montana Western Student Handbook, click links for a downloadable pdf. Note that all resident students are obligated to live in on-campus housing and participate in the meal plan offered by Montana Western. Current costs for room rental, meal plan, and other fees are listed on our website.

I agree to abide by the terms and conditions of the housing contract and the Montana Western student code of conduct.

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Roommate Preference and Compatibility

Resident Contract