Temporary Housing Host Information Form

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On Campus Mom Foundation

Email *

Form Completion Date:
*

YYYY

Name of Host: *

Sheltering Location: Address, City, State, Zip Code *

Phone number: Cell (add home if applicable) *

Affiliation with Baylor University: *

Parent

Alumnus

Required

Please specify if there is a gender of student(s) you are willing to host: *

Male

Female

No Preference

Required

Due to allergies, please advise if there are there any pets in the home? *

Cat(s)

Dog(s)

None

Required

Duration of Shelter Provision:

As needed to complete internship - Summer Break

As needed to complete internship - Winter Break

I am willing to host both Summer and Winter Break

Other:

Submission of Identification:

Please kindly transmit an image of your state issued ID under separate cover after submission of this form to Volunteer@ocmfoundation.org. Transmission of this document will be utilized to better facilitate the initial physical contact with the host and student.

I will be submitting an image of my state issued ID to: volunteer@ocmfoundation.org

I will not be sharing my ID with The OCM Foundation, Inc.

Compensation for Housing:

Many students do not have the financial resources to support the housing component involved with participating in an internship. I agree it is my responsibility to provide to The OCM Foundation, Inc. a valuation of contribution for the provision of room and board in exchange for a letter of contribution.

Yes

The OCM Foundation, Inc. will serve as a bridge to connect students and/or a student's family who is need of shelter with the host as listed above. I, the individual(s) listed above, does hereby grant permission to The OCM Foundation, Inc. to share my information when a need arises. *

Yes

Comments:

A copy of your responses will be emailed to the address you provided.

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