EmailMeForm
Room Change Request
Name
*
First
Last
Email
*
Current Hall and Room Number
*
Primary Reason for Request
*
Please select
Concern with current roommate
Desire to live alone
Desire to live with a new roommate
Financial concern
If you have concerns with your current roommate, what steps have you taken to resolve this concern on your own? Please select all that apply.
Had an in-passing conversation with my roommate
Had a sit-down conversation with my roommate
Talked with my RA
Had a mediated conversation with my RA between my roommate and myself
Reviewed and/or revised our roommate agreement
Other
If you want to live alone, which of the following is the primary reason to live alone?
Please select
Mental health concern
Desire for more personal space
Bad roommate experience
Other
If you have financial concerns, which of the following best describes the financial goal achieved by moving rooms?
Please select
Move from a single room to a double
Move from a more expensive room to a less expensive room in a different building
If you want to live with a new roommate, where are you hoping to move?
Please select
On the same floor
To a different floor
To a different building
If you want to live with a new roommate, please provide their name.
First
Last
Proposed Roommate Housing Assignment
Agree if all information is true.
*
Yes, all information above is true.
If you are found to have falsified the report, your request for a room change may be denied.
