Housing Questionnaire

Internship Housing Questionnaire

Your Name: *

E-mail address: *

Are you able to host a Midd kid for some portion of Winter Term: the month of January?: *

Yes

Which nights can you host?: *

Home Address: *

Home Phone: *

Do you prefer a male or female?: *

Male

Female

Either

How should we describe sleeping arrangements? (e.g., twin bed in separate bedroom, sofa bed in study, etc.) : *

How far do you live from the closest public transportation? Is it bus/subway/commuter rail? - please specify line and stop. : *

Are you able to help the student reach public transportation?: *

Yes

If the student is interested, is it your intention to provide breakfast and dinner?: *

Yes

Limitations (e.g., smoking, alcohol)? : *

Please specify any other factors of interest to potential guests (e.g., your family members, location, pets, characteristics of : *

Email Address: