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HOST Student Registration Form

Simply complete the following HOST Registration electronic form, and let us know when and where you will be traveling.

The Office of Alumni Programs will then contact alumni in the requested area and find an available host for your specified time frame. We will match you with alumni first by geographic request and second by specialty.

Once a host is identified and notified of the match, we will then share contact information with you. It is up to you to call your host and share the details of your travel and interview arrangements.

After you return from your interview, we ask that you send a thank-you note to the host alumnus/a expressing your gratitude for their hospitality.

FIELDS IN BOLD ARE REQUIRED.

Please make sure that your first name, last name, email and at least one phone number are entered
First Name:
Middle Name:
Last Name:
E-mail:

Please provide at least one phone number where we can reach you:

Home Phone:
Cell Phone or Pager:
Preferred time to reach
you during the day:

Campus Address:

Street Address:
City:
State:
Zip Code:

Traveling:

If you will be traveling during the months of November-February (holiday, clinical rotations, other residency interviews, etc.), please provide approximate dates of travel and the suggested way to reach you during these periods: