| *Name: |
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| *Business Street Address: |
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| *Business City: |
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| *Business State: |
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*Is your location accessible by Public Transportation?
(T, commuter train, bus): |
Yes
No |
*Please indicate closest public transportation stop
and approximate distance from office: |
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| *Business Email: |
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| *Home/Mobile Phone: |
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| *Your Organization’s website: |
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| *Business Phone: |
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| *Your Job Title: |
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| *Career Field: |
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| *Employer: |
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| *Industry/Focus of your business/organization: |
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| *Please very briefly outline your 3 main responsibilities: |
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| *Suffolk Degree: |
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| *Major: |
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| *Year of Graduation: |
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| *Number of sophomores you can host: |
|
| *If you can host your student(s) during spring break, please check the dates you are able to host (check as many as apply to your situation): |
Monday 3/11
Tuesday 3/12
Wednesday 3/13
Thursday 3/14
Friday 3/15 |
| *If you can host at other times during the spring semester, please indicate when you can do so between February 10 and April 26): |
|
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