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Roommate Wanted Form
ROOMMATE WANTED REGISTRATION
Today's Date: * 
Last Name: * 
First Name: * 
Phone: *  
Cell: 
Email Address: *  
MTI program enrolled in:
Hometown & State:
Preference of Roommate
Gender:
Tobacco Use:
Interest & Hobbies:
Please check one of the following::
Number of bedrooms:
Number of rommates needed:
Total monthly rent $:
Total monthly utilities $:
A list of roommates including the above information will be mailed to you after registration week.Please fill out your current address
Address: * 
City: * 
State:
Zip: *