Students

HOST (Help Our Students Travel)

HOST (Help Our Students Travel) — In the HOST program, alumni HOSTs provide fourth-year students with a free place to stay for one or more nights as students travel for residency interviews. HOSTs also may choose to provide meals and local transportation, but that is not expected. If the HOST program would benefit you — it takes place in the fall and early winter months — please fill out and submit the form below. If you would like more information, please contact us.

Please fill in the form completely. Fields marked with an * are required.

HOST Student Registration

All fields marked with an * are required.

Name * Title First Last Suffix
Gender * Male Female
Home contact information
Address *
Street address

Address line 2

City

State / Province / Region

Postal / ZIP Code

Country
Phone * - (###) - ### ####
Email *
Confirm email *
Work contact information
Address
Street address

Address line 2

City

State / Province / Region

Postal / ZIP Code

Country
Phone - (###) - ### ####
Email
Confirm email
General information
If yes, what is your spouse's/partner's name?
Do you smoke? * Yes No
Do you have any allergies/any other consideration for housing placement? * Yes No
If yes, please provide more information.
Trip 1
Trip 1 - Dates that lodging is needed (nights only) *
Trip 1 - Location (include nearby metropolitan areas) *
Trip 1 - Interview hospital/institution *
Trip 1 - Residency specialty *
Trip 1 - Do you have your own transportation? * Yes No
Trip 1 - Will your spouse/partner be accompanying you? (If so, we will need to confirm that the host is able to accommodate your request.) * Yes No
Trip 2
Trip 2 - Dates that lodging is needed (nights only)
Trip 2 - Location (include nearby metropolitan areas)
Trip 2 - Interview hospital/institution
Trip 2 - Residency specialty
Trip 2 - Do you have your own transportation? Yes No
Trip 2 - Will your spouse/partner be accompanying you? (If so, we will need to confirm that the host is able to accommodate your request.) Yes No
Trip 3
Trip 3 - Dates that lodging is needed (nights only)
Trip 3 - Location (include nearby metropolitan areas)
Trip 3 - Interview hospital/institution
Trip 3 - Residency specialty
Trip 3 - Do you have your own transportation? Yes No
Trip 3 - Will your spouse/partner be accompanying you? (If so, we will need to confirm that the host is able to accommodate your request.) Yes No
Trip 4
Trip 4 - Dates that lodging is needed (nights only)
Trip 4 - Location (include nearby metropolitan areas)
Trip 4 - Interview hospital/institution
Trip 4 - Residency specialty
Trip 4 - Do you have your own transportation? Yes No
Trip 4 - Will your spouse/partner be accompanying you on this trip if the alumni host is willing to accommodate s/he? (We need to confirm that the host is able to accommodate your request.) Yes No

Students

HOST (Help Our Students Travel)

HOST Student Registration

HOST Student Registration

Home contact information

Work contact information

General information

Trip 1

Trip 2

Trip 3

Trip 4