EXTERN SPONSOR HOMESTAY HOST FORM  

Ursinus College greatly appreciates your participation. Your role is integral to the success of the Externship Program.

As a Extern Sponsor Homestay Host please submit the below information:

Please complete the following information:

*First Name :     

*Last Name :     

*Preferred Email Address :     

*Preferred Phone :       EXT:

*Address 1 :     

Address 2 :     

*City     

*State :     

*Zip Code:     

Please indicate your status :     

Alumni Class Year/Child's Class Year :     

If alumni, please indicate your undergraduate major(s) :          

Can you sponsor a home stay during the Extern Week (January 13-17 2014)

If yes, how many students?          

Do you have any pets? If yes, dog, cat, bird, other (Please fill in)

Please describe the Extern's living arrangement (Private/shared bathroom, air mattress on floor of den..)

Is Public Transportation Accessible in your area?

Briefly describe the public transportation :

Are there any other particular concerns which a potential homestay student should take into account about these arrangements? Please describe.

 



* Required Fields