Host Program Form: Student Request

Host Program Form: Student Request

Welcome to the University of Illinois College of Medicine HOST Program student request form. This service is designed for students who are participating in the National Resident Matching Program (NRMP) and seeking residency placement in the coming year. This program aims to facilitate a connection between student requests and alumni volunteers who are able to host students or provide additional guidance for residency interviews in their local area. 

HOST Program Process

We are in the process of formally building the HOST Program and are working to find optimal alumni hosts across the country to fit student requests. Although we will work diligently to find a local alumni host we cannot guarantee a host. We encourage students to book alternative lodging that could be cancelled if and when a host is identified. 

Please fill out the below student request form. Once we receive your completed request we will reach out to alumni in our database who have expressed interest in hosting students visiting their area during their residency interview process. Once we have confirmed their interest and availability during your travel dates we will connect you directly with the alumna/us via email. 

It will then be the student’s responsibility to follow-up with the host to arrange specific arrangements and logistics. We ask that when you connect with or stay with an alumna/us that you remember that you are representing the University of Illinois College of Medicine and conduct yourself in a professional and respectful manner during your visit. Also, we encourage you to send a follow-up thank you note upon returning from your visit. 

Fields in RED are mandatory

First Name 
Last Name 
Degree Track 
Please select the COM site location where you are located 
Anticipated Graduation Year 
Anticipated Specialty 1 
Anticipated Specialty 2 
Phone 
Phone Type 
Email 

HOST INFORMATION

  
Non-smoking host household 
Host household with children 
Host household with pet(s) 
 
Please describe pet preference: 
Dietary restrictions 

TRAVEL INFORMATION

Note: Please indicate, City, State, Medical institution and Residency program in fields below. We cannot guarantee placement, but consider prioritizing residency host based upon needs.
  
Location 1 City, State 
Institution 1, Res. Program 
Location 1 Dates Needed 
Location 2 City, State 
Institution 2, Res. Program 
Location 2 Dates Needed 
Location 3 City, State 
Institution 3, Res. Program 
Location 3 Dates Needed 
Location 4 City, State 
Institution 4, Res. Program 
Location 4 Dates Needed 
HOST Program Requests – please check all that apply:  HOST Homestay (stay at an alumni home)
 HOST Meal (sharing a networking meal with alumni)
 HOST Resource (connect with alumni to receive local information resources via phone or email, or connection during a month-long away rotation)
    Additional Comments 
    Terms and Condtions  I have read and agree to the terms and conditions of the waiver of liability, hold harmless and public release agreement for the University of Illinois College of Medicine HOST Program. Full document can be viewed here. 


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