Host Family Inquiry

Please complete this form if you are interested in hosting an international student in your home.

* REQUIRED

*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State/Province:
*Zip/Postal Code: (ex: 00000)
County
*Nearest Large City or Metro Area:
*Day Phone: (ex: 000-000-0000)
Evening Phone: (ex: 000-000-0000)
*Email Address:
I am 18 years old or older:	Yes No
Name of Local Public High School:
City/Town where High School is Located:
I am interested in a student from:
I am interested in hosting a:	Male Female Either
How did you hear about CCI? Please check all that apply
I have previously hosted with CCI
Internet Craigslist Facebook Google VolunteerMatch.com Other Internet (specify): Community CCI Host Family Exchange Student CCI Local Coordinator Friend/Relative Church School My Child Local Store/Restaurant Newspaper Radio Event (specify): Magazine (specify): Other Community (specify):
Your Local Coordinator (if any):

I am applying to be a Local Coordinator for CCI:
*Have you hosted for another exchange organization?	Yes No
If yes, what organization?

Comments:

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