DEPARTMENT OF HOUSING AND RESIDENCE LIFE ROOMMATE AGREEMENT WORKSHEET

EMPLOYEES’ COMPENSATION DIVISION LABOUR DEPARTMENT STATEMENT OF
BILL LOCKYER STATE OF CALIFORNIA ATTORNEY GENERAL DEPARTMENT OF
COMMITTEE ASSISTANCE DEPARTMENT INTERNATIONAL & ENVIRONMENTAL PLANNING

US DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION
DATE INDIANA DEPARTMENT OF TRANSPORTATION ATTN INDOT PROJECT MANAGER
STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DIVISION OF ENTERPRISE

Department of Housing and Residence Life

Department of Housing and Residence Life

Roommate Agreement Worksheet

In completing this agreement, the residents of this room have already reviewed A Guide to Creating a Positive Roommate Relationship and agree to establish a positive living environment. Each roommate agrees to abide by the terms and conditions established in the same manner as the housing policies published in the student handbook. In the event that the terms and conditions of this agreement have not been honored, we will seek to resolve the matter with each other, and if necessary, seek the support of a Residence Life staff member.

We agree to the following behavior ____Lights off ____ on ____Small light on

while a roommate is sleeping: ____TV/music off ____ on ____Low volume

____Computer off ____ on ____Sound off

The following times are acceptable for study: Weekdays: start_______________ end_______________

Weekends: start_______________ end_______________

The following times are acceptable for Weekdays: start_______________ end_______________

Social/Entertainment (TV, visitors): Weekends: start_______________ end_______________

In regards to use of alcohol _______________ never in the room

_______________ responsible for and understand consequences

_______________ should not let it affect living environment

We request that family and friends Before: Weekdays_______________ Weekends_______________

not call/knock: After: Weekdays_______________ Weekends_______________

We agree to the following about Visitors: Overnight stay: yes____ no _____

Opposite sex yes____ no _____ When__________________

Prior notice: yes____ no _____

How far in advance?_______________________

We will leave messages/phone messages by: _____next to phone _____on a memo board

_____request they leave message on machine

We agree to the following regarding room Personal items picked up___________________________

cleanliness: (daily, weekly, bi-weekly) Dishes done_______________________________________

Room swept/dusted/vacuumed_____________________

Other__________________ Other________________

The following items may be borrowed/used _____food _____clothes _____school items

with permission: _____personal items _____appliances

_____Other:_________________________________

Items should be returned to owner by: _______________

If damaged, should be replaced by: __________________

Items off limits to anyone but the owner are: ________________ _______________ _______________

In regards to room security, we agree to _____always lock door _____lock only when gone long

_____lock when asleep ___lock when roommate knows

*Your signature is a pledge to positive community living and a promise to honor agreements put forward*

*Anything not listed above may be listed on a separate piece of paper then attached to this worksheet*

Roommate_________________________________ Roommate__________________________________

Residence Life Staff Member_____________________________________ Date__________________

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