The International Office

630 Dartmouth Place

CCIS
Evanston, Illinois 60208 – 4190
Phone (847) 491-5613

COMMUNITY COUNCIL CCIS HOMESTAY PROGRAM

FOR
INTERNATIONAL Through the CCIS Homestay Program you are housed by a local individual or
STUDENTS family for 2 – 5 days before your permanent housing is available. You will
stay in contact and continue your friendship through your stay at
Northwestern.
Return this form to the International
Office or send it by mail or fax to:
The Community Council for International Students is a volunteer community
Greta Sims organization formed to help students from other countries during their stay at
3015 Normandy Place Northwestern University. It hopes that there will be mutual sharing of values,
Evanston, IL 60201 cultural experiences, and interests between the international student and local
families.
Email: rgsims@att.net
Fax: 847-328-7397 Our volunteers welcome you!
Phone: 847-328-7394 Though your time here may be short, we hope that it is an agreeable time for
(only local calls can be returned)
you and that your stay in the United States is happy, productive, and
satisfying.

HOMESTAY APPLICATION

TODAY’S DATE (mm/dd/yyyy): _____ / _____ / _____ HOME COUNTRY: ______________________________________

NAME: ___________________________________________________________________________________________________
(Family Name) (First Name) (Middle Name)

FIELD OF STUDY: ____________________________________ EXPECTED COMPLETION DATE: _____ / _____ / _______

FLIGHT INFORMATION (please arrange your own transportation from the airport):

Airline: _____________________________________________ Flight #: ______________________________________________

Arrival Date and Time: _______________________________________________________________________________________

How many days would you like to stay with your host (2 – 5)? _______________________________________________________

HOME COUNTRY ADDRESS: ______________________________________________________________________________

LOCAL ADDRESS: ________________________________________________________________________________________

LOCAL PHONE: _________________________________ E-MAIL ADDRESS: ______________________________________

(Area Code) (Number)

CAMPUS:  Evanston  Chicago

DATE OF BIRTH: _____ / _____ / ________

GENDER:  Male  Female

(over) Last updated 6/6/2007
 HOMESTAY APPLICATION
(page 2)

Is your Evanston/Chicago housing confirmed?  Yes  No

*Please note that Homestay is only available to individual students, not families.

MISCELLANEOUS INFORMATION

Will you have the use of a car while you are here?  Yes  No
Do you smoke?  Yes  No
Do you have allergies?  Yes  No
If so, what? _________________________________

Do you have a special diet (religious, vegetarian, medical)?  Yes  No

If so, what? _________________________________

Have you lived in the U.S. before?  Yes  No

Where? __________________________________________ For how long? ____________________________________________

Languages spoken: __________________________________________________________________________________________

Special Interests: ____________________________________________________________________________________________

__________________________________________________________________________________________________________

Additional comments you would like to tell us: ___________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Last updated 6/6/2007