| Please answer the following questions: |
| 1) Street address |
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2) City
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3) State
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4) Zip Code
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5) Country |
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6) Preferred email address
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7) Daytime Phone
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9) Address at which you are willing to provide housing (please write "same" if same as above):
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10) How long are you willing to have the student stay with you? Please specify dates.
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| 11) What type of accommodations are you able to provide?
Couch Private room/shared bath
Private room and bath Other (please specify)
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| 12) Do you have children living in your house? No Yes (Please specify number and ages)
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| 13) Do you have pets? No Yes (Please specify number and kind)
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| 14) Is your home Smoking Non-smoking Smoking outside only Other (Please specify)
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| 15) Will the student have access to kitchen facilities? No Yes Sometimes (Please specify)
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16) What hours would you like your student visitor to keep?
No preference I have a preference (Please specify, i.e. In by 9 pm, not up before 6 am, etc.)
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17) Please tell us how accessible your home is by public transportation (e.g. 5 minute walk to the T and commuter rail, etc.)
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18) Are there any other things the student guest should know about you and your home? (example: we need help walking our dog; the student can do laundry on Saturdays in our home; student can play music, but not too loud (thin walls), we are one block from a shopping center, absolutely no overnight guests, etc.)
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19) I am volunteering to house the student. No rent, fees or household services will be expected in exchange for housing. Yes
No. We have agreed on the following fee:
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Liability Information:
By participating in the CGI Internship Program by housing a student, I understand that I assume all risks and responsibility for any loss or damage that may occur as a result of my participation, including but not limited to: loss of or damage to personal property including consequential losses arising there from; loss arising as a result of death, illness or injury to either myself, others in my household or the participating student. Mount Holyoke College and the Center for Global Initiatives of Mount Holyoke College are not responsible for any participating students, and do not insure the participating students for their liability to you or others, or make any guarantee with respect to the student’s behavior, or her financial responsibility. Mount Holyoke College and the Center for Global Initiatives of Mount Holyoke College are not responsible for any participating host, and do not insure any activities arising out of the CGI Internship program. Participating hosts and students will be mutually responsible to resolve any differences or claims between themselves, and Mount Holyoke College or the Center for Global Initiatives of Mount Holyoke College will not assume any responsibility for any such matters.
General Information:
In the event that the student must be asked to vacate my home before the agreed-upon date, I agree to give her no less than 48 hours notice.
I understand that it is my responsibility to communicate with the student before agreeing to house her, in order to determine whether she will be compatible with my household.
I agree with the above information.
I do not agree with the above information and therefore can not offer housing to a CGI Intern.
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