Fillable Printable Roommate Agreement Sample Form
Fillable Printable Roommate Agreement Sample Form
Roommate Agreement Sample Form
O:\Forms\Roommate Agreement\Roommate Agreement Form-8.5 x 11 size.doc
Roommate Agreement Form
Building: ____________________________ Room/Apt #_________________
Communication is essential for a positive relationship with your roommate(s). To facilitate this process, it is important to address living preferences.
Please use the following document in this manner:
1. Respond to each question with your own preference, each roommate individually.
2. Examine and discuss the differences with your roommate(s).
3. Try to agree on a way to resolve those differences before conflicts arise, in a manner that will be satisfactory to all of you. This may involve
compromise, so please be open and flexible, yet assertive of your own needs.
* * * *
Community/Personal Property
My roommates may use these possessions of mine:
Roommate
Name:
-----------------------------
----------------------------
-------------------------
-------------------------
-------------------------
Notes/Comments:
Stereo/I-Pod
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
TV/Video
Games
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Furniture
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Appliances
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Yes ____ No ____
Ask First ____
Clothes
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Food
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Computer
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Cell Phone
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Other
Responsibilities
A second area of potential difficulty is “responsibilities”. It is important for roommates to share the responsibilities that are part of the
residence hall/apartment experience. Things such as cleaning the room, keeping the room secure, messages and phone use, and other
shared responsibilities for the living area are all important matters that cannot be neglected.
1. Security
I agree to lock the door whenever I leave and not give out my ID card and pin so others have access to our room. I also understand
that failure to do so could constitute negligence, resulting in a fine. If theft or vandalism to property in the room/apartment results
from my negligence, I understand that I might be held liable for the loss.
Roommate #1 initial:_____ Roommate #2 initial:_____ Roommate #3 initial:_____ Roommate #4 initial:_____ Roommate #5 initial:_____
2. Cleaning
How will cleaning the floors (sweep, mop, vacuum) be arranged?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How will the trash and recycling be dealt with?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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How will cleaning the bathroom and shower be arranged?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How will cleaning the kitchen area (stove, refrigerator, dishes, etc.) be arranged?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
What other cleaning responsibilities will there be? (common areas, windows, etc.)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
3. Messages
To avoid problems the following is agreed upon:
Messages will be handled in the following manner:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Late night cell phone conversations will be allowed under the following circumstances and in the following locations:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
4. Quiet Hours (for sleep, study)
What hours will be set aside for sleep or study time (no other activities or noise within living space)?
Weekdays: ____________________________________________________________
Weekends: ____________________________________________________________
Most weeknights I expect to get to sleep by (time):
#1 ________ #2 ________ #3________ #4________ #5________
I expect to get up most weekday mornings by (time):
#1 ________ #2 ________ #3________ #4________ #5________
5. Visitation
This section must be completed and on file with your RA for you to be able to have a visitor. Please go to the following link to
register your guests when they arrive to campus: http://www.uwgb.edu/housing/current/guest/register.asp
Roommate
Name:
-----------------------------
----------------------------
-------------------------
-------------------------
-------------------------
Notes/Comments:
Visitors
Allowed
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
Yes ____ No ____
Ask First _____
How Many
Male?
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Female?
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Visitors
allowed
anytime?
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
For what
Purpose . . .
Study
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Social
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Restricted days & times to have a visitor: _________________________________________________________________________
When I’m gone my roommate’s guest may use my:
Roommate
Name:
-----------------------------
----------------------------
-------------------------
-------------------------
-------------------------
Notes/Comments:
Bed
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
TV/Video
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
O:\Forms\Roommate Agreement\Roommate Agreement Form-8.5 x 11 size.doc
Games
Computer
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Other
For those areas where we differ on visitation preferences, we have decided to compromise in this manner (list areas and compromise):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
6. Problem Solving
When a conflict arises between any of us concerning our living preferences, we agree to take these steps to resolve the issue:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
7. Other
If you encounter any problem that you have not talked about in this agreement, you should modify this agreement to suit the situation. All
roommates must take part in the process in order for it to succeed. Please describe any other agreements that all of you are making:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
* * * *
If problems do occur, you and your roommate(s) must make all the efforts necessary to solve the problems between yourselves. It is best to try to
resolve the disputes between yourselves. Your Resident Assistant is available to assist you with roommate issues at any time. Your residence life
handbook outlines the appropriate steps to settle disputes in a satisfactory manner.
We as roommates intend to abide by all the policies we have made. We agree to be flexible and revise this agreement as it becomes necessary.
Roommate #1 Signature__________________________________________ Date: _________________
Roommate #2 Signature__________________________________________ Date: _________________
Roommate #3 Signature__________________________________________ Date: _________________
Roommate #4 Signature__________________________________________ Date: _________________
Roommate #5 Signature__________________________________________ Date: _________________
Please return one agreement per room/apartment to your Resident Assistant when you are finished.
Your RA will return a copy to you shortly. Please display a copy where all roommates may view.
