SHARED HOUSING QUESTIONNAIRE
Demographics
Age _______ prefer roommate(s): near own age _____­­_____ older _______ younger __________
Male ___ Female ___ Willing to live with: men only ____ women only ___ men or women _________
Number of people want to live with _____ couples _____ singles ____ children _________________
Present or former occupation(s) _____________________________________________________
Highest level of education _______  Are you a student _____ School/major ____________________
Hobbies _______________________________________________________________________

Housing Preferences
Area desired  ____________________________________________________________________
Areas not acceptable ______________________________________________________________
Do you need a place without stairs ____________________________________________________
Do you need to be near public transit _____ which line(s)___________________________________
Maximum rent you can afford including utilities _______________ without utilities ________________
Willing to work in exchange for rent __________ work can do ______________________________
Prefer furnished or unfurnished apartment ______________________________________________
Need parking ______ Need storage space  ____________________________________________

Household Composition
Do you have children _____ How many ______ Ages & sexes ____________________________
Do you have a pet or animal aide ____ what kind _____ how many _________________________
Are you willing to live with animals ____ what kind ___________________ how many __________

Personal Habits
Do you use tobacco ____ what kind ________________________ how much ________________
Willing to live with someone who smokes _____________________________________________
Use of alcohol _________________________________________________________________
Use of other mood-altering substances _______________________________________________
Willing to live with someone who drinks ______________________________________________
How do you feel about people borrowing from you _____________________________________
How do you feel about borrowing from others _________________________________________
Favorite type(s) of music _________________________________________________________
Types of music not willing to listen to _________________________________________________
Hours when it is OK for music to be playing ___________________________________________

Standards of housekeeping - check your preferences:
            everything must be neat and clean                  ___________
            housekeeping is important but not central       ___________
            prefer neatness but not fussy                          ___________
            housekeeping not a major issue                      ___________
            not interested in housekeeping                       ___________

Health Considerations
Are you on a special diet ___________________________________________________________
Are there any dietary limits you would have about someone you live with (ex., vegetarian only)
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Do you have any health conditions a roommate should know about ___________________________

Lifestyle Issues
How often do you want to have guests over ____________________________________________
How often could your roommate have guests ___________________________________________
What hours are you usually at home __________________________________________________
Do you prefer: solitude _____ mixed solitude & company ______ togetherness _________________
Do you expect to share activities, social life, companionship with your roommate _________________
Which activities would you want to share ______________________________________________

Are there any other concerns you would have about a roommate or living situation _______________
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Is there anything else a roommate should know about you _________________________________
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