Please submit this form by Friday, January 18. If you have questions, contact Betsey Walsh. Personal Information First Name (required) Last Name (required) Email (required) MIT Address MIT Phone (required) Home Address Home Phone (required) Hosting a Student in Your Home Please select the dates you are available to host and provide housing for prospective students. Indicate your gender and smoking preferences, the type of accommodation you are able to provide, and information about any pets. Saturday February 9Sunday February 10Monday February 11 Saturday February 23Sunday February 24Monday February 25 Saturday March 9Sunday March 10Monday March 11 Student Gender: FemaleMaleNo Preference Smoking Preference: Non-smokerSmokerNo Preference Accommodations: Private RoomShared RoomFutonDaybed/CouchOther (explain below) Additional Information: List any pets: Hosting a Student in a Hotel Please indicate if you are willing to be a host for a prospective student staying in a hotel on any of the following dates: February 9 – 11February 23 – 25March 9 – 11 Open House Events Please indicate your availability: Sunday, February 10: Pit HostCampus or City TourResidence Tour Sunday, February 24: Pit HostCampus or City TourResidence Tour Sunday, March 10: Pit HostCampus or City TourResidence Tour Available hours: *Note: Pit hours are 12 – 5 p.m. Name of residence hall to tour: Monday, February 11: LunchDinner Monday, February 25: LunchDinner Monday, March 11: LunchDinner Note: Lunch is hosted in Building 68, Room 180/181 from 12:30 – 1:30 p.m. Dinner will be hosted from 6 – 8 p.m. and will include a group of faculty, current students, and prospective students (location TBD). Interests and Experiences We would like to match visiting students with current students who share non-scientific interests through hosting, sharing a meal, or another informal interaction. If you feel you can provide a perspective on the MIT experience for members of one or more of the groups below, please check the relevant box(es). You may also list any special interests or hobbies. Married and/or with childrenWomen in scienceInternationalReligious (please specify below)LGBTQFirst-generation college studentDisabledOther (please specify below) Additional Information: Undergraduate Institution Would you like to meet or correspond with prospective students from your own undergraduate institution, if they request such a contact? YesNo Mentoring Would you be interested in serving as a mentor for an incoming first year student? YesNo
