Name of Resident: VISHAKHA SINGLA

Floor RA(s)’s Name: NISHTHA DANI

Room Number: 231

Residence Hall Number: RH4

Part A
This section of the form should be filled independently. If you have a
different answer than what is listed, write your own response. After
completion of Part A, sit down with your roommate to discuss your
responses and then complete Part B.

ROOM CONDITION
1. Regarding the appearance of the room, I prefer that it be:
a. Orderly and Clean ☐
b. In between ☐
c. Messy ☐

d. No Preference ☐

ATMOSPHERE OF THE ROOM:

1. I prefer the windows to be:
a. Open ☐

b. Closed ☐
c. Depends on the weather ☐
d. Depends on the time of the day ☐

e. No preference ☐

2. When I am in the room, I prefer the temperature of the room to be:

a. Cold- I need both the fan and the A/C on at all times ☐
 b. Cool – I need the A/C on at all times ☐

c. Moderate – I need the fan on at all times ☐

d. Warm – I do not switch on either one of them ☐

ACTIVITIES IN THE ROOM

1. I generally sleep between the hours of:
a. _____ and _____ on weekdays
b. _____ and _____ on weekends

2. When I sleep I need: (select as many as applicable)1

a. The room to be completely dark ☐

b. A light to be on ☐
c. The room to be completely silent ☐

d. Music to be played out loud ☐

e. Others: ☐

3. When I am sleeping my roommate can: (select as many as applicable)

a. Listen to music out loud ☐

b. Use their laptop ☐

c. Talk on the phone ☐
d. Video chat ☐

e. Use their headphones ☐

f. Have peers over ☐

g. Have the ceiling lights on ☐

h. Have a desk light on ☐

1Quiet Hours are to be observed between 01:00 am to 07:00 am every day. During Quiet Hours, you are
expected to refrain from playing music or creating loud noise in the rooms, washrooms, hallways,
common rooms etc.
 i. Other: ☐

If other, please specify:

4. When I study I: (select as many as applicable)

a. Need complete Silence ☐
b. Listen to music out loud ☐
c. Listen to music on my headphones ☐

d. Study with a group ☐

e. Have no preference ☐

f. Study outside the room ☐

g. Other: ☐
If other, please specify:

5. My roommate can talk on the phone/ video chat in the room when:
a. I am not studying ☐

b. I am not sleeping ☐
c. Both (a) and (b) ☐
d. I am not in the room ☐

e. It does not matter ☐

6. When it comes to eating food in the room:

a. I do not want anyone to eat inside the room ☐

b. I do not mind anyone eating in the room ☐

c. There are certain things I do not want people eating in the room, like:
_____________
STICKY, SWEET FOODS
 PEERS IN THE ROOM2
1. I prefer that my roommate’s peers:
a. Be welcome anytime ☐

b. Leave when I study ☐

c. Leave when I am in the room ☐
d. Leave when I am sleeping ☐

e. Other: ☐
If other, please specify:

2. I require ______________ before peers are invited to the room:

a. No intimation
b. An advanced warning of a couple of hours
c. Others:
If other, please specify: Just a little heads up

3. My roommate's peers are allowed to: (select as many as applicable)

a. Use my bed when I am not there ☐

b. Eat my food (with my permission) ☐

c. Eat my food (without requiring prior permission) ☐
d. Use other belongings, such as _________ ☐

e. Other: ☐
If other, please specify:

5. If my roommate’s peers break one of my belongings or anything else in the room:

I expect them to apologise and work out the details with me
_________________________

2 Please note that all visitation should be in consonance with the University Residence Life Policy on
Security and Visitation.
6. Any specific arrangements/concerns with respect to visitors of other genders?
Just give me a fair heads up

COMMUNICATION
1. If my roommate is upset with me and needs to discuss something, I prefer they:
a. Talk to me directly ☐

b. Leave me a written note ☐

c. Talk to our RA ☐
d. Other: ☐

If other, please specify:

2. When I am upset:
a. I prefer to talk things out ☐
b. I need space and time to deal with it on my own ☐

c. I need to blow off steam, and then I will be okay ☐

d. Others: ☐
If other, please specify:

3. If I am gone for a long time:

a. I will let my roommate know when I expect to return ☐

b. I think it is unnecessary to notify each other ☐

ROOM SECURITY
1. The room should be locked when: (select as many as applicable)
a. One roommate leaves ☐
b. When both roommates leave ☐
 c. At night when either one/ both roommates are asleep ☐

d. Other: ☐
If other, please specify:

2. Do you think both roommates should carry the room keys whenever they leave the
room?
a. Yes ☐
b. No ☐

If other, please specify:

3. With respect to my personal belongings, I prefer that:

a. My roommate does not touch my personal belongings ☐
b. My roommate can touch/use my personal belongings after asking for
permission first ☐

c. My roommate can touch/use my personal belongings at any time without my

permission. ☐

OTHER
1. 1. Any pet peeves your roommate should know about:
I really don’t like dirty shoes in the
room and lets try not to the let the floor
get wet

1. 2. Any allergies or other health concerns you think your roommate should know
about:

Thank you for completing Part A of your Roommate Agreement form. Together with
your roommate, kindly fill and sign Part B.