University of Illinois at Urbana–Champaign
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| |States’ 4-H International Exchange Programs |
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| |SUMMER INBOUND HOST FAMILY CHECKLIST |
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National Office: 720 Third Ave., Suite 2205, Seattle, WA 98104
❑ Host Family Description This document describes the role and expectations of a host family, and gives some of the reasons why hosting is an excellent way to explore the cultures of the world.
❑ Extension Volunteer Application First time families are requested to complete to become Extension Volunteers.
❑ Host Family Application & Picture Application for families to complete and attach a picture.
❑ Confidential Host Family Reference Host family gives this form to 2 individuals to complete. Forms should be confidential and returned to Miriam Rosenbohm (see below for address).
❑ Child Abuse and Neglect Tracking For the safety of our participants, all household
System (CANTS) members living at the address of the applicant (12 years and older), are required to complete a background check through CANTS.
❑ Conviction Information Name For the safety of our participants, all household
Check Request for Volunteers members living at the address of the applicant (18 and older), must complete this form so that a State Police conviction check may be performed.
❑ Host Family Media & Liability Release To be read and signed by at least two adults within the host family.
❑ Copy of Driver’s License and Proof All household members age 21 and older must provide
of insurance a copy of their driver’s license and proof of auto
insurance.
Completed forms should be returned to:
Miriam Rosenbohm
8412 W. Middle Road
Peoria, IL 61607
If you have questions, please contact Miriam Rosenbohm at 309.697.4041 or rosenbohm07@
Important information to note:
• Japanese Inbound participants are tentatively scheduled to arrive the third week of July and will depart the third week of August.
The earlier Host Family applications are received increases the chances for finding a suitable match for the host sibling.
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