Summer RISE 2019: Host Registration
Thank you for your interest in hosting one or more Montgomery County Public School (MCPS) Summer RISE students. We are very excited to be partnering with you.

By completing this registration form, you are agreeing to host one or more MCPS high school juniors or seniors for 3 weeks from Monday, July 8 through Friday, July 26, 2019. It is suggested that you host at least two students for 20 hours per week and no more than 60 hours total during the three weeks.

Email from the Summer RISE program organizers will be our primary method of communication along with posted updates on our website: www.MCPS-SummerRISE.org. Please make sure that the host email you submit is the one you want MCPS to use to provide updates on the Summer RISE program. Please also make sure you have read the 2019 Summer RISE Host Agreement before submitting this form.

Should you not be able to complete this registration form all at once, complete the required sections (noted with the red asterisk) and press the submit button. You will be emailed a link you can use to return to the registration process at a later time.

Questions? Email or call Elaine Chang-Baxter at Elaine_L_Chang-Baxter@mcpsmd.org or call 240-740-5599.
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MCPS Form 496-2G
February 2019
Email address *
Host Information
Please include the primary contact person's information.
Host First Name *
Your answer
Host Last Name *
Your answer
Host Title *
Your answer
Host Office Number *
Your answer
Host Cell Number
Please note that this will only be used for an urgent matter.
Your answer
Please complete the following information if you anticipate that there will be an alternate contact if the primary host may not be available on any given day or time at your office from July 8 - July 26, 2019.
Alternate Host First Name
Your answer
Alternate Host Last Name
Your answer
Alternate Host Title
Your answer
Alternate Host Email
Your answer
Alternate Host Office Number
Your answer
Alternate Host Cell Phone
Please note that this will only be used for an urgent matter.
Your answer
Company Information
Company/Organization Name *
If MCPS, write "MCPS-Name of Organization" (ex."MCPS-Budget Unit" or "MCPS-Redland MS")
Your answer
Street Address *
Your answer
Suite Number
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Company/Organization Mission
Your answer
Company/Organization Website
Your answer
Type of Company/Organization *
Types of departments in your company/organization. Please check all that apply. *
Required
What types of industries does your company/organization represent? Please check all that apply. *
Required
How many students will your company/host? *
Your answer
Please describe your vision for the student opportunity. *
Your answer
Will you be hosting students at more than one department or more than one site? If yes, you will be sent a spreadsheet to provide more details including the points of contact, departments/addresses for the other hosts/sites and a description of the experience(s).
If we can match you with a bilingual student, which language(s) would be preferred?
Check all that apply.
Would your company/organization be willing to make a philanthropic contribution to the Montgomery County Public School Educational Foundation, Inc. which is a 501(c)(3) nonprofit Maryland corporation to help pay for the educational components of Summer RISE program costs? Click here to provide a gift/contribution: https://www.mcpsfoundation.org/pages/our-programs/summer-rise
Confirmation
Electronic Signature *
Link to host agreement and details about it...
Required
Name (First and Last) *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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