Host Program

Student Registration

The HOST Program matches alumni across the country with fourth-year medical students who are traveling to their residency interviews, typically during the months of October through January. Please complete the registration form below. Thank you for participating!

Please keep our office informed of any changes in plans you may have. If you make other arrangements and no longer require a host, inform us first by e-mailing Sarah Chester at schester@upenn.edu.

*Required Fields

1. Please provide the following information:

* First Name
Middle Name
*Last Name
*Address 1
Address 2
*City
*State
*Zip
*Class Year
*Home Phone
*Cell Phone
*E-mail

2. My gender is:*

Male Female

3. I prefer to stay with a host of the following gender:*

Male Female No Preference

4. I am looking for a host who can provide the following during my residency interview (Check all that apply):

	Lodging
	Meals
	Information about residency programs
	Assistance finding a location to live when matched
	Transportation to my residency interview

5. The specialty I am interviewing for is:*

6. Please provide the following information about your residency interviews:

Interview #1
*Date of Interview (mm/dd/yy)	Select Date
*Medical Center (complete name)
*City, State of Medical Center
*Dates I Need Overnight Lodging (mm/dd/yy)	Select Start Date to Select End Date
*My spouse or significant other will accompany me. Yes No
Name of Spouse/Significant Other
Mode of Transportation to Interview

Interview #2
Date of Interview (mm/dd/yy)	Select Date
Medical Center (complete name)
City, State of Medical Center
Dates I Need Overnight Lodging (mm/dd/yy)	Select Start Date to Select End Date
My spouse or significant other will accompany me. Yes No
Name of Spouse/Significant Other
Mode of Transportation to Interview

Interview #3
Date of Interview (mm/dd/yy)	Select Date
Medical Center (complete name)
City, State of Medical Center
Dates I Need Overnight Lodging (mm/dd/yy)	Select Start Date to Select End Date
My spouse or significant other will accompany me. Yes No
Name of Spouse/Significant Other
Mode of Transportation to Interview

7. Additional comments or information (special needs, dietary restrictions, allergies to household pets, etc.)

CAPTCHA:

(antispam code, type the 3 black symbols only)

If you have more than three interviews scheduled and need further assistance with the HOST program, please complete another registration form. This form can only handle up to three requests per registration.

We look forward to assisting you in your search!

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