City: State: Zip:
Technology of Interest:
Date of Birth: Male or Female
1. Roommate: (Name of Another Freshmen)
2. Do you smoke?
3. Do you keep your room neat and orderly?
4. When do you generally go to bed?
5. When do you generally get up?
6. Does light bother you when you are trying to sleep?
7. What are your musical preferences?
Rock Country Rap Classical Jazz New Age Other
Other Music (Specify)
8. Do you prefer to study with the radio on?
9. Do you plan to stay on campus most weekends?
10. Do you have any have any physical conditions, which would effect your housing assignment, ie. allergies, limitations of mobility, etc.?
If yes, please explain below or call to advise of such.
11. Indicate your hobbies, interests or high school activities.
12. Extracurricular activities you plan to pursue at Stevens.