STUDENT HOUSING REQUEST 2016-2017
Office of Student Leadership Development, Illinois Mathematics and Science Academy
The information on this form is required of all students returning to IMSA for the upcoming academic school year. Failure to provide complete information will impact your housing placement. Residential Life staff will make decisions for housing based on the formation of a positive living and learning community. Therefore, you must understand that this form is ONLY A REQUEST. If you have not found a roommate by the deadline, you still need to fill in your preferences and turn in your form on time and you will be matched with another student at RC discretion. This form is due to your first choice hall by 5:00pm on Sunday, March 22nd.
ROOMMATE REQUEST:
Roommates should discuss with one another their personal habits and lifestyles before submitting a rooming request. It is strongly recommended that each roommate pair meet with their 1st choice hall/wing RC before submitting their request for review.
Student Name: Click here to enter name Student Name: Click here to enter name
Student ID: Click here to enter name Student ID: Click here to enter name
Current RC Signature: _________________________ Current RC Signature: _________________________
ROOM ASSIGNMENT REQUEST:
Housing Preferences: Please number the following factors in order of importance 1-4; 1 being most important, 4 being least. Your priorities will be considered and assist our decisions, but are not guaranteed.
Hall: Choose one Wing: Choose one Friends: Choose one Room type: Choose one
(check one): Quad L-Room
Standard Double
Hall Preferences: Rank the halls in the order in that you wish to live in, 1 being your first preference, 4 being your last. You may only select each hall once. For your first choice building, please rank the four wings in the order in which you would like to be placed.
1. Choose one Choose one Choose one Choose one Choose one
2. Choose one Choose one
3. Choose one
4. Choose one
Room Location (optional): If you wish to submit a request to be taken into consideration as to where you are placed please check the appropriate boxes. Upstairs room Downstairs room Quiet room
COMMUNITY MEMBER REQUEST
If you would like us to consider placing you with specific students in a community, please list up to six individual people. It is suggested that you list students outside of your first choice hall in the event that you are not placed there.
1. Click here to enter name 2. Click here to enter name 3. Click here to enter name
4. Click here to enter name 5. Click here to enter name 6. Click here to enter name
DUE TO YOUR FIRST CHOICE HALL OFFICE BY: Friday, April 1st at 5 pm
We understand that this form is ONLY A REQUEST and the Housing Coordinators will make all final placements. We understand that if our roommates do not return to the Academy next year, a new roommate will be assigned and our housing placement may be re-assigned. We also understand that the decisions made will be final and based on the needs of the community.
Please print the completed form and sign below. Turn the form in to your first choice hall for review.
Student Signature:____________________________ Student Signature:______________________________