Room Change Request
Current Hall and Room Number
Primary Reason for Request
Concern with current roommate
Desire to live alone
Desire to live with a new roommate
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
If you want to live alone, which of the following is the primary reason to live alone?
Mental health concern
Desire for more personal space
Bad roommate experience
If you have financial concerns, which of the following best describes the financial goal achieved by moving rooms?
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?
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.
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.