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Abortion Assistance Lodging Support Host Application
Application form to be a host for people needing a place to stay while accessing abortion care in the Twin Cities metro area.
Email address *
First Name *
Your answer
Last *
Your answer
Street Address and Number *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Have you lived out of state or out of country in the last 10 years? If so, where? *
Your answer
Do you have a criminal background, or any other criminal history to share with us? (We will be performing a background check) *
Your answer
Preferred gender pronouns
Languages spoken fluently by yourself, or other members of your household. *
Your answer
What type of space do you have available? *
Please use this space to give a quick description of the available space (furniture & layout, etc.) *
Your answer
What type of pets, if any, live in your household or on the household property? *
Required
Which days of the week would this space be regularly available? (We will follow up with you to clarify the details and specifics of your availability. We also understand that your space may become temporarily unavailable and that your schedule may change. There will be guidelines for changing/updating your availability once you have been accepted as a Host.) *
Required
Will any transportation assistance be available? *
Required
Please check any other information that applies to the available space: *
Required
Please describe your home's typical at-night environment (e.g. sound levels, activity, other persons around, etc.) *
Your answer
Why are you interested in being a host? *
Your answer
Please describe in 3-5 sentences why you support access to abortion care. *
Your answer
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