HSIC Attendee Information

Hometown (city and state)

List any special dietary needs:

Please list any chronic or acute medical conditions (if none, please put NA)

Please identify all known allergies to foods, medicines, insect bites, etc. and the nature of the reaction (if none, please put NA)

If you are currently taking medication, please identify the medication and, if you choose, the reason for its use (if none, please put NA)

Please upload an image of the front and back of your insurance card

Please select a file

In case of emergency, the following should be contacted:

Typically, when do you plan on going to sleep at night?

Do you sleep with music playing?

What time do you typically wake in the morning?

I describe myself as someone who is

Please select the top five traits that best describe you.

Do you use air pods or headphones when watching videos on your phone/device or when listening to music?

Please list any medical or special needs related to housing

(e.g. wheelchair access, allergies, learning accommodations or specific study needs, etc.)

Is there anything that would be helpful for us to know in assigning you a roommate?

Talents and Hobbies: Please tell us a little about you and what you like to do in your free time.

What are some of your favorite things?

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