Requester Legal Name:
Requester Preferred name:
Email:
Gender:
Birth Date:
Are you a smoker: Yes I smoke I am not a smoker and I do not object to living with a smoker I object to rooming with a smoker
Which housing style(s) did you select on your housing application?:
Which room types did you select on your housing application?:
Is there any other information you would like to provide?
Information Release
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