Gender Neutral Housing Application

Dartmouth College seeks to provide a living environment welcoming to all gender identities; one not limited by the traditional gender binary. Gender neutral housing allows for same-gender, opposite-gender or other-gender identities to live together regardless of biological sex. This program floor will provide a living/learning environment where residents can learn about and explore gender identity and expression in a supportive environment. Available housing options include a five-person suite, a three-person suite, and four two-room doubles.

Due Dates

Fall Term: April 5, 2013
Winter Term: October 4, 2013
Spring Term: January 31, 2014

Personal Information

First/Preferred Name:

Middle Initial:

Last Name:

Date of birth:

Cell phone number:

E-Mail address (@dartmouth.edu):

Application

While you are not required to provide information about the following, this information may be helpful in placing you with a compatible roommate or suitemates.

What is your biological sex? Female Intersex Male

What is your personal gender identity? Man Woman Additional Gender Identity

If "Additional Gender Identity" is selected, please specify:

Do you have a third-person pronoun you prefer to be addressed by? If so, which one?

Please provide anything else you wish to share about your gender identity, gender expression, or biological sex to help us in the housing assignment process:

Room/Suitemate Matching/Preferences

Do you have a room/suitemate preference? Yes No
(Please note: We cannot guarantee that all room/suitemate requests will be honored)

If yes, please provide the student(s) names and Dartmouth ID numbers:

You prefer that your room/suitemate(s) gender identity is: Man Woman No Preference

If "Additional Gender Identity" is selected, please specify:

You prefer that your room/suitemate's biological sex is: Female Intersex Male No Preference

How would you describe your ideal room/suitemate?

Provide any other information that would be useful in matching you with a room/suitemate:

Housing for Medical/Disability Needs

If you anticipate the need for residential accommodations related to a medical condition or disability, please complete the appropriate special needs form at http://www.dartmouth.edu/~orl/housing/forms/.

Will you be applying for special accommodations? Yes No

Community Building and Shared Learning Activities

Residents are expected to participate and be present for programming events as much as possible outside of coursework and other responsibilities. It is expected that you will make it to most of the events since these are community building activities. There will also be Sunday discussions at 11:30am (lasting approximately ninety minutes). Please try not to schedule nonacademic activities during the Sunday discussion times.

Will you be able to commit to the Sunday discussion time? Yes No

Please respond to the following questions:

1. Why are you interested in the gender neutral program floor?

2. What previous experience with exploring gender (academic, personal, and/or community) do you bring with you to this program?

3. Please describe any dialogue, facilitation or leadership training experience (DPP, Deep Community, LDP, etc.) that you have completed either on campus or off.

4. What else, if anything, would make you a strong candidate for the program floor?

While we do our best to respect your housing requests, we do not guarantee that you will be assigned to the roommate(s) or room type requested. Vacancies occurring after the initial assignment process will be filled either from individuals already accepted into the program or from pull-in requests. Any resident requested as a pull in must first apply and be accepted to the program for the move to occur.

Information provided in this document will only be shared with the Gender Neutral Housing Selection Committee and the Program's advisors and Community Director.

I have read, understand, and agree to abide by the College Residence Policies & Terms.

Student signature: (type your full name)

Last Updated: 2/28/13