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Golden Roomies Profile Page
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* Indicates required question
Requirements to participate
*
You are 55+ years old
You will agree to a background check
You can take care of yourself without assistance
You are willing and able to provide proof of income
Required
If all "Requirements to participate" boxes are not checked, may we contact you for further clarification?
Yes
No
Clear selection
Today's date:
*
MM
/
DD
/
YYYY
What is your full name?
*
Your answer
What is your preferred contact number?
*
Your answer
What is your primary email address?
Your answer
What is you current address?
*
Your answer
Are you wanting to stay in your home and bring on a roommate?
*
Yes
No
What is the highest degree or level of education you have completed?
*
Some High School
High School
Bachelor's Degree
Master's Degree
Ph. D or Higher
Trade School
Prefer Not To Say
What is your age range?
*
55-65
66-70
71-75
76-80
81+
Other:
What is your current living situation?
*
Your answer
What is your monthly income?
*
Less than $1,500
$1,500-$2,500
$2,500-$3,500
$3,500-$4,000
More than $4,000
Where were you born?
*
Your answer
How long have you lived in Arizona?
*
Less than 5 years
5-15 years
16-25 years
25 +
Born and raised in Arizona
What is your religious preference?
*
Your answer
Please specify your ethnicity?
*
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other/Unknown
Prefer Not To Say
What gender do you identify as?
*
Male
Female
Prefer not to say
Other:
Do you smoke?
*
Yes
No
Are you married?
*
Yes
No
Divorced
I have never been married
Do you have children?
*
None
1-2
3-4
More than 4
Prefer not to say
Are you an introvert or extrovert?
*
Introvert
Extrovert
Required
What did/do you do for a job?
*
Your answer
What city or cities would you prefer to live?
*
Your answer
What do you find most enjoyable?
*
Your answer
Do you have any unique talents?
*
Your answer
What are your hobbies?
*
Your answer
How important is it to keep your home neat and clean?
Not important - a messy home may not bother me
Somewhat important - you prefer a tidy and clean home, but sometimes you many not get around to cleaning up right away
Very important - you like to have everything in its place
Clear selection
What time do you like to go to sleep?
*
Around 7pm
Around 8pm
Around 9pm
After 9pm
What is your stance on sharing food and personal items?
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Keep everything separate
Sharing food is alright, but not personal items
Sharing everything is alright with me
Do you like to have people over to socialize?
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Yes
No
Maybe
What are your thoughts on over night guest?
*
Ok, if it is not more than a day or two
Prefer not to have overnight guests
Other:
Do you have a pet(s)?
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Yes
No
Are you ok with pets?
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Yes
No
Other:
If you do have a pet(s), what type of pet(s) do you have?
*
Dog
Cat
Other:
Do you drink alcohol?
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Yes
No
Do you like to cook?
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Yes
No
If you like to cook, how often do you cook per week?
*
1-2 time per week
3-4 times per week
5-6 times per week
Everyday
How do you like to spend your free time?
*
Your answer
What challenges have you faced in past living situations?
*
Your answer
What are you hoping for in a roommate?
*
Become great friendship
Become good friendship
Roommate to help share expenses
Other:
What does your ideal roommate look like?
*
Your answer
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