Roommate Information Form

Boston University Medical Campus
Roommate Information Form 2005/2006
Please complete the form below and press the “submit” button.  The information will be sent directly to Dave Rini, BUMC Housing Resource Manager.
Last Name:

First Name:

Email Address:

Street Address:

City:

State:

Zip:

Phone:
2nd Phone:
Best Time to Call:
Please describe some of your academic interests:
Please describe some of your outside interests:
Please describe any dietary preferences you may have:
Affiliation:
Medical School Graduate School School of Public Health
Dental School Current Resident Other
Contact Information:
Greg Wheeler
Email: gwheeler@bu.edu
Address: Harrison Court
Office of Rental Property Management
19 Deerfield Street floor 1
Boston, MA 02215		 Phone: (617) 353-4101
Fax: (617) 353-3737
Primary teaching affiliate
of BU School of Medicine