Clone of MI Spring 2026 College Tour Roommate Request Form

1

16th Annual Dr. Joyce M. Dixon HBCU Tour
Trip dates: March 29–April 2, 2027
Please only Submit ONE form per room. Please keep in mind that any student not paired in a room will be assigned to a room by the Motivational Foundation Staff. Co-ed rooms will NOT be permitted.

2

Your Name * This field is required.Name of Student Completing this form

First Name

Last Name

3

Gender* This field is required.

Male

Female

4

Do you have preferred roommates? * This field is required.If so, please continue with the rest of the form. If not, scroll to the bottom to submit!

YES!No, I don't have a preference

5

Name of Student

First Name

Last Name

6

Gender

Male

Female

7

Has the above student agreed to be in a room with you?

YESNO

8

Name of Student If you dont have anyone to occupy this spot, a student will be assigned

First Name

Last Name

9

Gender

Male

Female

10

Has the above student agreed to be in a room with you?Has the above student agreed to be in a room with you?

YESNO

11

Name of StudentIf you dont have anyone to occupy this spot, a student will be assigned

First Name

Last Name

12

Gender

Male

Female

13

Has the above student agreed to be in a room with you?

YESNO

14

Please read and check the following statement to indicate your agreement: I acknowledge and agree that each room can accommodate up to 4 students of the same gender. In the event that a room request has fewer than 4 students, additional student(s) will be added by the Motivational Foundation Staff.* This field is required.

I agree to the above statement