Homestay Hosting Form
Please complete the form below. The information that you share with WorldChicago will only be used for its intended purpose of homestay hosting involvement. For more information about the security of your information, please read WorldChicago's Privacy Policy at https://www.worldchicago.org/privacy-policy.
APPLlCATION FORM
Full Name
*
First Name
Last Name
Primary Email Address
*
example@example.com
Alternate Email Address
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Neighborhood
*
APARTMENT/CONDO/OR FLOOR (If not applicable, please leave blank)
Is this a single family dwelling or condo/apartment?
Please Select
Yes
No
Not applicable
If condo/apartment, #of bedrooms
How did you hear about WorldChicago?
*
Please Select
WorldChicago Newsletter/email
WorldChicago Facebook
WorldChicago Twitter
WorldChicago Instagram
WorldChicago LinkedIn
WorldChicago Staff
WorldChicago Board Member
Friend/Colleague
Event
WC YPG
WC:Youth Diplomat
Google/internet search
Other
If you selected friend/colleague, please list their first and last name below (If not applicable, please leave blank)
First Name
Last Name
If you selected event, please specify below (If not applicable, please leave blank)
Please Select
Young Professionals
Happy Hour
Spring Diplomacy
Other
If you selected other please specify below (If not applicable, please leave blank)
If you selected WorldChicago Youth Diplomat, please explain below (If not applicable, please leave blank)
How many people 18 or over live with you?
*
Please Select
0
1
2
3
4
5+
Adult #1
Please specify your relation to Adult 1 (If not applicable, please leave blank)
Please Select
Child
Spouse
Significant Other
Roommate
Other
If you selected other, please specify below (If not applicable, please leave blank)
Adult #1: Full Name
First Name
Last Name
Adult #1: Primary Email
example@example.com
Adult #1: Alternate Email
example@example.com
Adult #1: Birthday
-
Month
-
Day
Year
Date
Adult #2
Please specify your relation to Adult 2 (If not applicable, please leave blank)
Please Select
Child
Spouse
Significant Other
Roommate
Other
Please enter the first and last name of Adult 2 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
If you selected other, please specify below (If not applicable, please leave blank)
Please enter the primary email of Adult 2 who resides in your household (If not applicable, please leave blank)
example@example.com
Please enter a secondary email of Adult 2 who resides in your household (If not applicable, please leave blank)
example@example.com
Birthday: Adult 2
-
Month
-
Day
Year
Date
Adult #3
Please specify your relation to Adult 3 (If not applicable, please leave blank)
Please Select
Child
Spouse
Significant Other
Roommate
Other
If you selected other, please specify below (If not applicable, please leave blank)
Please enter the first and last name of Adult 3 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Please enter the primary email of Adult 3 who resides in your household (If not applicable, please leave blank)
example@example.com
Please enter a secondary email of Adult 3 who resides in your household (If not applicable, please leave blank)
example@example.com
Birthday: Adult 3
-
Month
-
Day
Year
Date
Adult #4
Please specify your relation to Adult 4 (If not applicable, please leave blank)
Please Select
Child
Spouse
Significant Other
Roommate
Other
If you selected other, please specify below (If not applicable, please leave blank)
Please enter the first and last name of Adult 4 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Please enter the primary email of Adult 4 who resides in your household (If not applicable, please leave blank)
example@example.com
Please enter a secondary email of Adult 4 who resides in your household (If not applicable, please leave blank)
example@example.com
Birthday: Adult 4
-
Month
-
Day
Year
Date
Adult #5
Please specify your relation to Adult 5 (If not applicable, please leave blank)
Please Select
Child
Spouse
Significant Other
Roommate
Other
If you selected other, please specify below (If not applicable, please leave blank)
Please enter the first and last name of Adult 5 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Please enter the primary email of Adult 5 who resides in your household (If not applicable, please leave blank)
example@example.com
Please enter a secondary email of Adult 5 who resides in your household (If not applicable, please leave blank)
example@example.com
Birthday: Adult 5
-
Month
-
Day
Year
Date
Children
How many people 17 or younger live with you?
*
Please Select
0
1
2
3
4
5+
Child #1
Please enter the first and last name of Child 1 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Birthday: Child 1
-
Month
-
Day
Year
Date
Relationship:
Please Select
Child
Sibling
Other
Child #2
Please enter the first and last name of Child 2 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Birthday: Child 2
-
Month
-
Day
Year
Date
Relationship:
Please Select
Child
Sibling
Other
Please enter the first and last name of Child 3 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Birthday: Child 3
-
Month
-
Day
Year
Date
Relationship:
Please Select
Child
Sibling
Other
Please enter the first and last name of Child 4 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Birthday: Child 4
-
Month
-
Day
Year
Date
Relationship:
Please Select
Child
Sibling
Other
Please enter the first and last name of Child 5 who resides in your household (If not applicable, please leave blank)
First Name
Last Name
Birthday: Child 5
-
Month
-
Day
Year
Date
Relationship:
Please Select
Child
Sibling
Other
Hosting Details
What age(s) are you interested in hosting, select all that apply:
*
Please Select
Adult (18-24)
Adult (25-35)
Youth (12-17)
All of the above
Length of stay willing/able to host (select all that apply)
*
Please Select
1 week
2-3 weeks
4 weeks
Do you have a preference of gender?
*
Please Select
Male
Female
All of the above
How many WorldChicago visitors are you able and/or willing to host overnight?
*
Please Select
1
2
3
4
5
6
7
8
9
10+
Do you have any concerns/special needs, etc. that you would like to tell WorldChicago? (If not applicable, please leave blank)
Are you okay with hosting a smoking guest in your household?
*
Please Select
yes
no
Is there smoking in the household?
*
Please Select
Yes
No
Prefer not to answer
If yes, please specify
Please Select
Pipe
Cigarettes
Vape
Other
N/A
How frequently?
Please Select
Hourly
Daily
Weekly
Monthly
N/A
How many languages are spoken in your household?
*
Please Select
1
2
3
4
5
6+
Which languages? Please check all that apply:
*
English
Spanish
Tagalog
Arabic
Polish
Chinese
Russian
Urdu
Other
N/A
Prefer not to say
If you selected other, please specify (If not applicable, please leave blank)
Please tell us about your family. This information will assist us in the matching process. (250-500 words)
Are all members of your household (who are eligible) fully vaccinated against Covid19? (Note: all WorldChicago international visitors are subject to International Travel Requirements set by the CDC)
*
Yes
No
Other
If you selected, "Other", please explain:
Do you have any household pets? (If not applicable, please put N/A)
*
If yes, please indicate the breed of animal, age, size, and weight (If not applicable, please leave blank)
Is there anything else you would like to share with WorldChicago as we review your application? (If not applicable, please leave blank)
By checking these boxes, I agree to the following terms:
*
I understand that the WorldChicago must follow certain federal and voluntary guidelines, which includes: (1) a virtual interview, (2) a criminal background check on all participants 18 years or older, and (3) a virtual orientation if necessary.
I agree to be interviewed by a representative of WorldChicago (~30min) to explain the responsibilities related to participating in this virtual exchange program.
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