Offer Housing to the HCW HOSTED Program

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Thank you for offering to donate the use of a housing unit for frontline healthcare workers to stay during the COVID19 pandemic. Our healthcare workforce is at high risk of unknowingly transmitting COVID19 from their clinical environment to their families or catching COVID19 from their families. Therefore, we are seeking to support the workforce, their families, and our health system by providing donated housing for self-quarantine. Please provide the requested information about the available property.

(Please note, we cannot accept offers for individual rooms in a home with other non-frontline health workers sharing the same space.)

Property Name *

Property Address *

Street, City, State, Zip

Name of closest hospital (if known)

Number of rooms available *

Number of kitchens / kitchenettes available *

Is food and beverage service available? *

Yes

Other:

Are there laundry facilities available for healthcare worker use? *

Yes

Other:

What is the earliest date are you willing to have your property available?

YYYY

How long are you willing to donate your property to frontline healthcare staff fighting COVID19?

Primary Contact Name *

Primary Contact Email Address *

Primary Contact Phone Number *

Secondary Contact Name

Secondary Contact Email Address

Secondary Contact Phone Number

Additional Information for the HCW HOSTED Team

Link to property (e.g. AirBnB listing, hotel website, etc)

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