Become a HOST Program Volunteer - Wayne State University

Fields with asterisks (*) are required.

Become a HOST (Alumni)

First name *

Last name *

Email *

Address line 1 *

Address line 2

City *

State/province/region *

Postal/zip code *

Country *

Preferred Phone *

Specialty *

Graduation Year *

Hospital/Business Information:

Retired? *

Hospital/Business Name *

Current position/Title *

Address *

City *

State *

Zip Code *

Hospital/Business Phone *

Hospital/Business Email *

How are you willing to help? (Check all that apply) *

Lodging for students

Transportation during visit

Lodging for a student and their significant other

Do you have pets?

If so, what kind?

Training hospitals in your area? *

Please indicate contact information that can be shared with prospective HOST students. (Check all that apply) *

Preferred phone

Both

Other

If other, specify