This questionnaire was developed to assist us in locating a suitable roommate for you in the New York City Area. Please feel free to email us any additional information which you believe would help us throughout this process.

First Name:    Last Name:  

Street Address & Apartment #                                        (your address information is for office use only and it will NOT be posted with your listing)

City  State Zip Code:   

Cross Street or Intersection:

Phone Number

Your Contact E-mail:


Best Hours to Call (M–F)

Your apartment has:   (How many total bedrooms & bathrooms are in your apartment)


Your Floor Number

The available bedroom is:    

Room Size : (approximate square feet or length by height)

Monthly rent for roommate to pay:*   please review how to optimize your asking rent

Is a security deposit required?* 

Average monthly utilities per roommate:*   (enter the per roommate amount or $0 if utilities are included in the rent)

Where is your apartment located?* 

Brooklyn           Bronx               Chelsea             East Village/Lower East Side
Gramercy Park   Midtown East    Greenwich Village/West Village
Midtown West   New Jersey       Queens              SoHo and Below
Upper East Side Upper West SideAbove 130th. St. Staten Island Long Island


Your Neighborhood Name:     

How long you have been in your apt? (approximately)

Date the room is available (mm/dd/yy)

Length of share:  

Please check off the following services & amenities that are applicable to your share:
Laundry Elevator Utilities Included Doorman Dish Washer Air Condition
Terrace Fireplace In-house Superintendent 

Other apartment or building services/amenities:

Your Age  Your Gender:  Male Female 

Do you smoke?  Yes No

Do you have any pets? No Pets Dog Cat Bird Other (explain in notes)

What typical weekday hours do you usually keep?  (Please, indicate from a.m. or p.m.)

What is your roommate gender preference?  (optional) Male Female No Preference

Couples considered: Yes No

What is your roommate age preference? (optional)  You can choose more than one range by holding down the Ctrl key and then selecting the desired ranges.

What is your smoking preference in a roommate?  No Preference No Smoking

What is your pet preference? 

No Pets (read about health benefits of living with a pet)

Will Consider Pets

What is your lifestyle preference in a roommate?  (optional) GLBT No Preference 

Hobbies and interests: 

Answer below if additional roommates will be in your apartment.

Additional Roommate No. 1 (other than yourself)
Please fill out the following 4 questions for each additional roommate living in apartment

Gender:  Male Female  

Smoker: Yes No 

Other Roommate‘s Age: 

Other Roommate‘s Occupation:

Additional Roommate No. 2 (other than yourself)
Please fill out the following questions for each additional roommate living in apartment

Gender:  Male Female  

SmokerYes No 

Other Roommate‘s Age: 

Additional Roommate‘s Occupation


Please enter any additional comments or information about yourself, your share or living space:

250 character maximum

Have you used Rainbow Roommates before? Yes No

If not, how did you find us?

Would you also consider renting (on a daily or weekly basis) your room/space to short term guests that are visiting or on vacation to NYC ?  Yes   No

Would you like information regarding related services such as: free home security review, apartment cleaning services, storage & moving services, and furniture rentals?                        

                                                                                                                            Yes: No:


1. The content of the information appearing in the listings provided by Rainbow Roommates to its client is the sole responsibility of those persons posting the information. Rainbow Roommates has no control over the information provided by potential roommates, and cannot guarantee the accuracy, integrity or quality of that information. Customers should rely on their own judgment and critical evaluation of the information provided. Rainbow Roommates will not be liable in any way for any content that may appear in its listings, including, but not limited to, for any errors, omissions, or misrepresentations, or for any lost profit, loss, or damage of any kind incurred as a result of the use, or misuse, of any information provided in such listings.  


2. Rainbow Roommates Memberships are non-transferable. Any information provided is for customers’ personal use only. Unauthorized transfer of a Rainbow Roommates Membership will result in termination of this agreement.

3. Rainbow Roommates Memberships will be processed in the order received. The activation of a membership and receipt of your first listing will not happen automatically after signing up online. Activation may be delayed, depending on the number of applications that precede yours. However, service is deemed to commence at the time the customer has access to the first listing.

4. Rainbow Roommates is not responsible for any Internet failure or periodic downtime due to systems upgrades.


By initializing here I agree to the above disclaimer & terms of service.

 < select here        << your initials here

If you have pictures of the apartment or room that you would like to include with your listing, send them to us via email to  info@rainbowroommates.com and we will include them in your listing.