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FAQ For Students
Student Host Evaluation
Registration – Host Student
We would love to hear from you! Please fill out this form for each interview and we will get in touch with you shortly.
First Name
*
Last Name
*
Host Gender
*
Male
Female
No Preference
I'm looking for a host to provide the following
*
Lodging during residency interviews
Transportation to interview
Information about residency program
Please note, this is preference. All options may not be provided. We will do our best to match you with a host who is able to provide as many of the requested services listed. **
Email
*
Preferred Phone Number
*
Preferred Phone Type
*
Cell
Home
Secondary Phone Number
Secondary Phone Type
Cell
Home
Pager
Other
Additional Comments
Special needs, allergies to household pets, etc.
Where are you interviewing
*
Provide Full Name of Medical Center
Medical Center Location
City, State
Street Address
*
Interview Date
*
What evening(s) will you require lodging in this area?
*
What is the specialty for which you are interviewing?
*
Will your spouse or significant other accompany you?
*
Yes
No
Maybe
During my visit, I plan to:
*
Drive my own car
Rent a car
Utilize public transportation
Other
If Other, please specify
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