We are delighted that you are interested in participating in our Community Connections Program, wherein we will match you with one of our students. The Community Connections Program will help ease the transition for new students to college life and a new community by:

Providing support and friendship to students away from home;
Introducing students to Presque Isle and northern Maine; and
Helping students access local resources such as retailers, physicians, or places of worship.

Below is a short questionnaire we are asking that you complete and return to us so that we may learn a bit about you. Your responses will assist us in better matching you with a student. Thank you for completing the application.

All fields required for submission. Please use N/A for not applicable
Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Email*
Summer Address*
- I have a different address in the summer
Summer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What are your interests?*
Please list your occupations*
Number of family members*
Ages of children*
Your Community Connections Program student would have what academic interests?*
Your preferred student would be what gender?*
What languages other than English do you speak?*
If you have pets, please list what type*
Would you be willing to host more than one student?*
Why are you interested in the Community Connections Program?*
Acknowledgement

By submitting this application, I agree to assume all risk of personal injury or loss, bodily injury (including death), damage to or loss of, or destruction of personal property, resulting from or arising out of my participation as a volunteer in the Community Connections Program. I also release, waive indemnify, hold harmless, and discharge the University of Maine at Presque Isle from all claims, damages, and injuries arising out of my volunteer activities. I understand that a background check may be performed on me or my significant other, at no expense to the university. I understand I will be required to supply my social security number if a background check is required.
Name
This field is for validation purposes and should be left unchanged.

Acknowledgement