Well-Being House, Residential Life

General contact: 45 Wyllys Avenue, Middletown, CT 06459, (860) 685-2000 • Office of Admission: 70 Wyllys Avenue, (860) 685-3000

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Area:	Well-Being House
Last Name:
First Name:
WesID:
Class Year:
Phone or Cell:
E-Mail:
Gender Identity:
Major:
I understand that by applying to live in this program house I may be placed in a double room. If I need a particular housing accommodation I will contact Stacey Phelps (sphelps@wesleyan.edu) prior to March 2nd, 2012:
Do you smoke? (Please read the Residential Smoking Policy):	YesNo
Would you live with a smoker?:	YesNo
Are you thinking about going abroad in the Spring?:	YesNoMaybe
If given a roommate, what gender identity must your roommate have?:	MaleFemaleDoesn't Matter
If so, do you have a roommate in mind?:
Would you be wiling to attend at least one program a semester at another Program house?:	YesNo
I understand that as a resident of the Program House I am required to participate in house events and Program House recruitment.:	YesNo
What is your definition of well-being, and how do you realize this in your life? Please be specific.:
Living in this house, you will be required to plan and participate in various programs for the community related to the mission of the house. What are some ideas you have for programs you would like to plan?:
Why is living in substance-free housing important to you?:
What are your interests and activities? What are you passionate about? Tell us about it.:
Describe your living habits: listening (to music), dietary, sleeping, studying, etc. Feel free to answer in any way you want.:
If you live here, you will most likely be living in a double. List 3 things you look for in a roommate.:
Write a haiku please. Enchant us with poetry. This is a haiku.:
Optional: We want to get to know you. Show us something you’re proud of! Feel free to stop by and bring your knitting project, favorite math proof, best friend, song, home-made bread, pet iguana, model robot, etc.:
Are you interested in the House Manager Position?:	YesNo
If so, why?:
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Well-Being House Application

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