Housing Questionnaire Student's Legal First Name* Student's Legal Last Name* Age* Home Address* Home City Home State/Province AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Home Country Legal Sex* Female Male Student Apartment OptionsAll student apartment units have 2 bedrooms and 2 bathrooms. They include a living room, kitchen, dining area, and patio or balcony. Apartments are unfurnished but do come with a standard twin bed for each student and major appliances (washer/dryer, fridge, oven/stove, dishwasher, and microwave. All apartments will have 4 students, 2 in each bedroom. IMPORTANT NOTE for those planning to utilize Federal Financial Aid for housing costs: The lease agreement will be for the entire 8.5 month academic year, but rent will be billed in two portions: fall and spring. This allows students the opportunity to utilize federal funds to cover housing costs.Roommate QuestionnaireTo best help us in placing you, please answer all questions as honestly as possible. This questionnaire is kept in strict confidence and is only used to help with your roommate placement.Do you plan to have a car in California?* Yes No Vehicle Make, Model, and ColorFor example: Ford Mustang, Red Vehicle State & License Plate NumberFor example: CA HDB78X9 I play and plan to practice an instrument in my apartment* Yes No If yes, which instrument(s)? Do you prefer to* Keep your room extremely neat and do not like when anything is out of place Keep your room relatively neat, allowing it to get cluttered occasionally Not worry about how your room looks, letting it get cluttered/messy most of the time? Do you have experience cooking, cleaning, grocery shopping, and doing your own laundry?* I have been doing all or most of these for several years I have recently started doing some or all of these I have always had someone do most or all these for me Do you prefer to go to bed:* Relatively early (generally before midnight)? Late (generally after midnight)? When you are studying, do you:* Get easily distracted, preferring quiet Prefer a little background noise like music or TV Study best with continuous background noise How do you feel about your roommate(s) using/borrowing your things?* What’s mine is yours It’s okay as long as they ask first What’s mine is mine, please don’t touch/use my things What is your preference regarding overnight guests?* I prefer not to have overnight guests Depends on the situation / who it is I love having guests and people can sleep over anytime! Please note that our student housing agreement states that you need the written permission of your roommates for guests to stay overnight; guests may stay no more than 3 nights per semester.How do you feel about rules:* Rules are there to be followed Rules are just guidelines and can sometimes be bent In many situations, I don’t feel like rules really apply to me Do you expect your apartment to be:* A fairly private place to relax and study A place where your friends come to socialize from time to time A place where people come over and hang out all the time Do you smoke?* I do not smoke I smoke cigarettes I smoke a hookah I smoke e-cigs / vape Are you okay with being placed with a roommate who smokes?*Smoking is not permitted inside the apartments or on the patio/balcony. Smoking is only permitted in designated smoking areas in the complex. Yes, it is okay if my roommate(s) smoke No, I do not want to live with someone who smokes What do you enjoy doing in your spare time? (check all that apply)* Play video games Outdoor activities Work out Do yoga/meditate Bake/cook Watch movies Play board/card games Read Listen to music Hang out with friends None of the above Is there anything else you would like us to know when considering your roommate placements? (allergies - dietary or environmental; dietary restrictions such as vegan or vegetarian; unusual sleeping habits such as insomnia, sleepwalking, must sleep with music/white noise, etc.)Please note that per the Leasing Agreement, pets are not allowed.GENDER IDENTITY The Young Americans and The Young Americans College of the Performing Arts has a diverse and dynamic student body and it is our mission to ensure all students and members feel safe and comfortable within the organization. As such, The Young Americans and The Young Americans College of the Performing Arts define gender as the gender with which the individual student/member self-identifies. While you are not required to provide information about your own gender identity, gender expression, sexual orientation or biological sex; this information may be helpful in placing you with compatible roommates. Your responses will be kept private and secure.Is your gender identity or gender expression different than your assigned sex at birth? No, my gender identity/expression is the same as my assigned sex at birth Yes, my gender identity/expression is different than my assigned sex at birth Prefer not to answer If your gender identity/expression is different than your assigned sex at birth and you would like to share your gender identity/expression with us, you may do so here:GENDER-NEUTRAL HOUSING YACPA offers a gender-neutral housing option. Gender-neutral housing provides a living environment that is not restricted to traditional limitations imposed by gender and/or sex definitions. This option is ideal for students whose gender expression, gender identity, and/or biological sex varies from the standard paradigm and for students who believe that their gender and/or biological sex should not be limiting factors in roommate decisions. All students will have the option to participate in, or opt out of, gender-neutral housing simply by indicating your preferences below. Please note that mixed gender apartments (both male and female in the same apartment) are only available through the gender-neutral housing option. Are you interested in Gender-Neutral Housing? Yes No If yes, we may ask for additional information and provide additional details regarding this option.Roommate Preferences / Special RequestsWould you like to room with someone from your hometown?* Yes No No preference Would you like to room with someone from your home state?* Yes No No preference For International Students: would you like to room with someone from your home country? Yes No No preference Is there anything else you would like to share with us regarding your roommate assignments / preferences?(please keep in mind that housing questionnaires are confidential and your honest/candid responses will assist us in pairing you with the best possible match)Roommate Requests If you would like to request specific people for roommates, you may do so below. You may submit up to 3 other names to be in your apartment. For requests to be considered, all parties must request each other (for example: if you want Susie Smith to be in your apartment, you must enter her name below and she must enter your name on her form). Please keep in mind that mixed-gender apartments (male and female in the same apartment) are only available if you’ve said yes to the gender-neutral housing option above. All other apartments will be all male or all female. Roommate requests are NOT guaranteed, and Student Housing Staff may choose to make alternate placements.Name #1 First Last Name #2 First Last Name #3 First Last Roommate assignments will be sent June 28th. We recommend waiting until assignments have been sent to determine what furnishing you would like to have in your apartment. Please be mindful when discussing furnishing options and budgets that students will be coming from a variety of financial situations.NameThis field is for validation purposes and should be left unchanged.
