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Instructions: To the best of our ability, your answers in this survey will remain confidential and anonymous. We will minimize any risks to breach of confidentiality by only using the information provided for the purposes of research. If you are in agreement with the previous statement, please respond to each question with the most appropriate answer.
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
How many roommates do you have (not including yourself)?
 
One
 
Two
 
Three
 
More than three
 
 
 
Did you know your roommate(s) prior to living with them?
 
Yes
 
No
 
 
Circle the most appropriate response to each statement.
Definitely Disagree Mostly Disagree Somewhat Disagree Neutral Somewhat Agree Mostly Agree Definitely Agree
I have a very close relationship with my roommate(s).
I trust my roommate(s) will not harm me or my possessions (this includes steeling, vandalizing, or any other action that will endanger you or your property).
I can rely on my roommate(s) to help me when I am in need of support (this includes any and all forms of informational and emotional assistance as well as helping complete tasks or chores).
My roommate often criticizes me and makes me feel bad about myself and my worth.
My roommate ignores my presences and my needs.
 
 
Circle the most appropriate response to the question.
Very Unsatisfied Moderately Unsatisfied Slightly Unsatisfied Neutral Slightly Satisfied Moderately Satisfied Very Satisfied
What is your overall satisfaction with your roommate relationship(s)?
 
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