Southern Illinois University School of Medicine Office of Alumni Affairs HOSTS Program

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HOSTS Program Student Evaluation

 
 
Your Name *  
 
Please provide your host's name and dates of stay.
 
Host's Name
 
     
Arrival Date Select date Calendar Icon  
Departure Date Select date Calendar  
     
How well did the HOSTS program meet your expectations? Please rate your HOSTS experience on a scale of 1 (Poor) to 5 (Excellent).
1 2 3 4 5
Comments:
Please rate the HOSTS Program registration process on a scale of 1 (poor) to 5 (excellent).
1 2 3 4 5
Comments:
Please rate your experience with the HOSTS family on a scale of 1 (poor) to 5 (excellent).
1 2 3 4 5
 
Would you recommend the host family to future students?
Estimate the cost savings (per residency interview) attributable to the HOSTS program.
$50-$100 $101-$200 $201-$300 Other
If other, please indicate:
 
Select the rewarding aspect(s) of participating in the HOSTS program. Check all that apply.
Getting a local perspective of the area / or program
Other (If other, please describe)
Please provide comments about your experience with the HOSTS program and/or the HOST family.
 
 

 

Phone 217-545-7800
P.O. Box 19650
Springfield, IL 62794-9650
The mission of Southern Illinois University School of Medicine is to assist the people of central and southern Illinois in meeting their health care needs through education, patient care, research and service to the community.

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