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Externship Host Application

Alumni/Parent Sponsor Information


First Name
Last Name
   
            Status (Check all that apply)
Alumni  Your Class Year
Parent   Child's Class Year
Friend of the College
Home Address
 
City
State
Zip Code
   
 Telephone
Email
Preferred Contact
 		 Email  Phone
 


Externship Location Information

 
 Organization Name
Sponsor's Title
   

Work Address
 
City
State
Zip Code
   
Telephone
Web Address
   

    Are you willing to host more than one extern? Yes No

                              If yes, how many?
   
    Briefly describe your organization and your work:
   

   What will the extern learn/observe during the externship?

 

Logistical Information


     Possible Dates for Externship. Please list a maximum of
     three options for a week-long stay. If you are doing the home
     stay  externs typically arrive on Sunday and depart Saturday:
 
Option 1
Option 2
Option 3
   
    Can you sponsor the home stay?   Yes No
    If No please scroll to the bottom and click Submit.
   
     Which of the following do you prefer to host?

  Male       Female      No Preference
 
     Do you have any pets? Yes  No
     If yes, do you have:  Dog(s) Cat(s) Both
   
    Will you provide meals for the extern?  Yes    No
   

    If student has special dietary needs (shared in advance) would
    that pose a problem for meal preparation? Yes   No

   
Please describe the extern's living arrangement (private/ shared
    bathroom, air mattress on floor of den):

   
Thank you very much. Please include any additional questions
    or comments that you may have:

   
      
   
 
 
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