Students - Have Housing Form

Date Available:
Last Name:
First Name:
Cross-Street address of home you are sharing:

City:
Your sex:
Male Female Male & Female Tenants
Roommate preferance
Male Female Either
Email:
Phone:
Miles from Anschutz Medical Campus:
Rent:
Deposit:
Total number of bedrooms in home	Total number of bathrooms in home

Private bath available:
Yes No
Pets Allowed: (Please add pets allowed/restrictions in the comment section below)
Yes No
Laundry:
Yes No
Smoking OK:
Yes No
I smoke:
Yes No
Does the new roommate need to bring bedroom furniture?
Yes No
If you have a completely furnished home, will you consider short term roommate situations for out-of-state health professional students on rotation, visiting international students, etc?
Yes No
If YES, we will add you to short term lists rovided to these visitors/short terms students. Typical stays are 4-8 weeks.
Pets are allowed on my lease, and your pets are allowed: (specify in comments below)
Yes No
I own a pet: (please specify in comments below)
Yes No
I drink alcohol:
Never Seldom Sometimes Often
I am:
Very Messy Messy Neat Very Neat
I study at:
Home Library Lounges Varies N/A
I am a:
Morning Person Night Person Varies
I invite company:
Never Seldom Sometimes Often
Comments: Use this to tell about how often company may be over, home environment, desired/ present (party animals, quiet all the time, do you drink/smoke/have lots of company, etc.) and whatever details you want to make sure prospective roommates have before they contact you.

All the information provided will be loaded into a separate document and shared with other students seeking roommate situations.