Please submit this form by Wednesday, January 17. If you have questions, contact Betsy Walsh. Personal Information First Name (required) Last Name (required) Email (required) MIT Address MIT Phone (required) Home Address Home Phone (required) Hosting a Student and Providing Housing 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 10Sunday, February 11Monday, February 12Saturday, February 24Sunday, February 25Monday, February 26Saturday, March 10Sunday, March 11Monday, March 12 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 10 – 12February 24 – 26March 10 – 12 Open House Dates Please indicate your availability: Sunday, February 11: Pit HostCampus or City TourResidence Tour Sunday, February 25: Pit HostCampus or City TourResidence Tour Sunday, March 11: Pit HostCampus or City TourResidence Tour Available hours: *Note: Pit hours are 12 – 5 p.m. Name of residence hall to tour: Monday, February 12: LunchDinner Monday, February 26: LunchDinner Monday, March 12: 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
