Contact Information:
Name:
Email Address:
Phone Number:
Preferred Contact Method:
Phone
Email
No preference
Personal Information:
Gender:
Male
Female
Occupation:
Undergrad Student
Graduate Student
Professional
Unemployed
Birthdate:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
Ethnicity:
Choose One
African American
Asian/Pacific
Caucasian/White
Eastern Descent
Islander
Latino
Middle Eastern
Native American
Other
Prefer not to say
Religion:
Choose One
Agnosticism
Baha'i Faith
Buddhism
Chinese Folk
Christianity
Confucianism
Hinduism
Islam
Jainism
Judaism
Shinto
Sikhism
Tribal Traditions
Zoroastrianism
Other
Prefer not to say
Sexual Orientation:
Straight
Bisexual
Gay/Lesbian
Personality:
  
Attach picture here:
Rental Preferences:
Neighborhood:
Ballard
Belltown
Capitol Hill
First Hill
Fremont
Green Lake
Laurelhurst
Magnolia
Queen Anne
Ravenna
Wallingford
Wedgewood
Occupancy:
Choose One
Single
1 Roommate
2 Roommates
3 Roommates
4 Roommates
5 or more
Are you willing to share a bedroom?
Yes
No
Are you willing to share a bathroom?
Yes
No
Please share any preferences regarding potential roommates: (ie: gender, age, personality, etc...)
General Comments: