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ROOMMATE i-MATCH

PAGE 1. ROOMMATE MATCHING INFORMATION.

Please answer the following questions to assist us in matching you with suitable roommates. (Note: if there is someone else filling out this survey, or another primary point of contact, we will ask for that later.)
(*) Indicates that the specified field is REQUIRED for you to submit the form.
You must have JavaScript enabled in your browser. If it is off, there will be a message in orange at the top of the page.
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You must agree with the Terms of Service to submit this form.
A. Information about the PERSON SEEKING A ROOMMATE:
Enter the name of the person seeking the roommate. Use alphabetic characters.
Invalid Input - age must be numeric and person must be over 18.
Provide a 4-digit YEAR of birth (e.g., 1992). The person must be over 18.
Select one of the choices provided.
Please select one of the choices.
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Please select one of the choices.
B. Information about the ROOMMATE(s) you are looking for:
Please select one of the choices.
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Please select one of the choices.
Are you able and willing to provide assistance to your roommate, such as reminders, prompts, assistance getting places, cooking, etc? This question is informational only and is not a commitment to provide assistance.
Please select one of the choices.
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PAGE 2. HOUSING INFORMATION.

Please enter information helping us to match homes and people. (If you are looking for a home, click B1 to answer questions about your housing preferences. If you have a home to share, click B2 to answer questions about your home.)
Chose one or the other.
B2. Information about the home or apartment YOU HAVE TO SHARE.
Please include the street address only, not the unit number.
Please enter a city name, alpha characters only.
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What is the estimated maximum monthly rent AND utilities that someone must pay or contribute to live with you? Please describe below.
Please enter a number. Do not include the decimal point or dollar sign.
Please choose which utilities someone must pay.
When will the room(s) be available to share? Note that these are estimations and can change.
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B1. Please provide information about the PLACE YOU WOULD LIKE to live.
Please choose where you would most like to live (your first choice).
Please indicate your second choice or pick "No second choice".
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What is the maximum monthly amount you can afford for your portion of the rent AND utilities?
Please enter numbers only. Do not include a decimal point or dollar sign.
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Invalid Input. Use letters, numbers, and valid punctuation.
Are you and another person (or persons) looking for someone to live with?
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Please identify the other person or people looking to live with you (e.g., friend, sister/brother, etc.).
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Total number of people who will share this housing?
Numbers only
When are you likely to be ready to move? Note that these are estimations and can change.
Please select one of the choices.

PAGE 3. Points of Contact for follow-up

Please provide contact information for the person who will be contacted if there is a potential roommate match. (This may or may not be the person seeking a roommate.)
Please select one of the choices.
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Please provide the first and last name of the person to be contacted.
Please provide the phone number of the point of contact. Use the same format as: 703-555-1212.
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Please provide a valid email address.
Please use the box below to include other pertinent information or explanations, or to ask questions. Do not include any personally identifiable information (PII) or protected health information (PHI). Thank you!
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Please check the "I am not a robot" box and follow its instructions.
Then after you have passed its tests, click the Submit button.
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