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1
Your First and Last Name
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First Name
Last Name
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2
Gender
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3
Do you have preferred roommates?
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Yes
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4
Student First and Last Name
First Name
Last Name
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5
Gender
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6
Has the above student agreed to be in a room with you?
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7
Student First and Last Name
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8
Gender
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9
Has the above student agreed to be in a room with you?
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10
Student First and Last Name
First Name
Last Name
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11
Gender
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12
Has the above student agreed to be in a room with you?
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13
I acknowledge and agree that each room can accommodate up to 4 students of the same gender. If a room request includes fewer than three students, The Motivational Foundation staff may assign an additional roommate.
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I acknowledge and agree.
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