Fillable ISHP Full Time International Student Application Final (Elgin Community College)

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ISHP Full Time International Student Application Final (Elgin Community College)

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Elgin Community College
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Application for Full-Time International Students
Page 2 of 8
Elgin Community College International Student Homestay Program
Application for Full-Time International Students
Community College District 509, commonly known as Elgin Community College, (“ECC”) is pleased to
offer the International Student Homestay Program to qualified F-1 international students enrolled full-
time at ECC in a degree program or the Intensive English Program, and/or J-1 exchange visitors where
ECC is the sponsoring institution. Please complete all fields of this application. Incomplete applications
will not be processed and will delay your placement into the International Student Homestay Program.
Applying for the International Student Homestay Program as a Student:
International students and J-1 exchange visitors who have been accepted to ECC may apply to the
ECC International Student Homestay Program. To apply, you must complete all items on the
following checklist:
1. Read, complete, and sign the Student Application for Full-Time International Students for the
ECC International Student Homestay Program.
2. Read and sign the Program Information, Policies, and Agreement for Full-Time International
Students for the ECC International Student Homestay Program.
3. Submit a letter of introduction with a current photograph. A digital photograph is
acceptable.
4. Submit your application by email to nescobar@elgin.edu, by fax to +1-847-214-7785, or by
postal mail to:
Elgin Community College
Center for International Education and Programs
1700 Spartan Drive
Elgin, IL 60123
United States of America
5. Once a homestay placement has been made, pay a one-time, non-refundable placement fee
of $100.00 USD in the form of cash, a cashier’s check or money order payable to Elgin
Community College, or with a credit card at www.peertransfer.com.
6.
The homestay application will only be processed once all above materials are received by the ECC
International Office and you have been accepted into ECC as an F-1 student or J-1 exchange visitor
(ECC must be the sponsoring institution for J-1 exchange visitors). For questions regarding eligibility,
please contact the Homestay Coordinator. You should submit your homestay application and
required documents no later than 60 days prior to your arrival in the U.S. The International Student
Homestay Program does not guarantee a homestay placement. However, most students are matched
with a host family if they submit their application by the application deadline. Applications for
homestay placement received after the application deadline will be filled based on availability.
Date of application:
(month/day/year)
Page 3 of 8
Please complete all fields of this application. Incomplete applications will not be processed and will
delay your placement. It is very important that you submit your homestay application by the
application deadline. Applications are due no later than 60 days prior to your planned arrival in the
U.S. Late applications will be filled based on availability.
Biographical Information
_________________
Planned arrival date in the U.S.:________________ ________________
(month/day/year)
Desired placement date:
(month/day/year)
Family Name/Surname: _________________________________________________________________
First Name/Given Name: __________________________________ Middle Name: _________________
Name you wish to be called: _______________________________ Gender: Male Female
Date of birth: ___________________
(month/day/year)
Age: ______ Social Security Number (if any): _________________
Country of birth: ____________________________ Country of citizenship: _______________________
Current address: ______________________________________________________________________
House Number and Street City/Town
_____________________________________________________________________________________
Province/State/Territory Country Postal Code
Home phone: _______________________________ Mobile phone: _____________________________
Email address: _________________________________________________________________________
Emergency contact name and phone: ______________________________________________________
_____________________________________________________________________________________
Native language: ______________________________ Other languages spoken: ____________________
English conversation level: None Beginner Intermediate Advanced
Family Members
Please provide the following information about your immediate family members:
Name Relationship Age Occupation/Study
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 4 of 8
General Housing Information
Please indicate the type of homestay placement you require:
Short-term (30 days)* without transportation: $600.00 per month
Short-term (30 days)* with transportation to and from school: $800.00 per month
Long-term (one semester/16 weeks) without transportation: $600.00 per month
Long-term (one semester/16 weeks)* with transportation to and from school: $800.00 per month
Special Programs with transportation: $27 per day.
*Please note there is a one month/30 day minimum for residing in a homestay. If you choose the short-
term (30 day) homestay option, you will need to secure housing beyond the 30 day period (such as a
local apartment or flat). Extensions of short-term homestays are not guaranteed. If you arrive for studies
mid-semester (such as for the Intensive English Program) and choose the long-term homestay option,
you will be in the homestay for the number of weeks remaining in the semester.
For how long do you require a homestay? 30 days 1 semester 2 semesters
Other: _______________________
Would you prefer a single room?
Yes No No Preference
If you are applying for a homestay outside of the U.S., have you received your visa from the U.S.
embassy/consulate?
Yes
No, I have applied for my visa but have not yet had my interview
No, I have not yet applied for my visa.
Are you applying through an agency? Yes No
If yes, please provide your agency name: __________________________________________
Contact person: ___________________________________ Agency Phone: _______________
Agency Address: ______________________________________________________________
Agency Country: ___________________________________ Agency Email: _______________
Would you prefer small children in your host family? Yes No No Preference
Would you prefer teenagers in your host family? Yes No No Preference
Would you prefer living with a host family that has no children? Yes No No Preference
Would you be comfortable living with unmarried or same sex partners?
Yes No No Preference
Would you be comfortable living with a single individual? Yes No No Preference
Would you be comfortable living with a host family that has a pet? Yes No No Preference
(Many Americans have indoor pets such as dogs, cats, etc.) Please note that requesting a
homestay without a pet may limit your chances of being placed with an American family.
Page 5 of 8
Do you have any pet allergies? Yes No If yes, to which animals are you allergic?
Do you smoke? Yes No
Please note that most of our hosts do not allow smoking inside the home. If you smoke inside the homestay,
you may be asked to move immediately. All smoking must be done outdoors. When smoking outside,
please dispose of your cigarette remnants properly.
Are you willing to live with a host or family member that smokes? Yes No No Preference
Would you be comfortable living with a host family that owns a firearm? Yes No
No Preference (Many Americans may legally own a firearm).
Do you plan to cook your own meals? Yes No No Preference
Do you plan to eat with your host family? Yes No No Preference
Do you have any dietary restrictions (medical, religious, vegetarian, vegan)? Yes No
If yes, please explain:
Arrival Information
Airport pickup from Chicago O’Hare International Airport or Chicago Midway International Airport is
provided by your host family if requested well in advance and based on availability. The fee for airport
pickup from Chicago O’Hare is $50.00 USD; the fee for airport pickup from Chicago Midway is $75.00
USD. This fee is payable directly to the host family along with the homestay fee and security deposit. If
airport pickup is requested, your host family will meet you at your flight’s baggage claim area with a sign
with your name on it. We encourage you to arrive on a weekend because your host family may not be
available for airport pickup during the week. Flight information must be received at least 21 days prior
to your arrival date.
Do you need airport pickup? Yes No
If yes, please provide: Arrival date: __________ Airline: _______________ Flight number: ____________
Arrival time: _________________________ Airport: __________________________________________
If no, how do you plan to get to your homestay?
Page 6 of 8
Will anyone be accompanying you to the U.S.? Yes No
If yes, please provide name, relationship, and duration of stay in U.S. for each individual accompanying
you. Note: Family members and/or friends who accompany you to the U.S. must make hotel
arrangements for their stay. The Center for International Education and Programs is happy to assist with
hotel recommendations.
Transportation
If you choose a homestay that provides transportation, you will be driven to and from ECC for classes
and activities and one weekly trip to the supermarket. Any other transportation needs must be
discussed with your homestay family. If you choose a homestay that does not provide transportation,
you will be responsible for making your own arrangements for local transportation. Few homestays are
within walking distance of campus, and public transportation is limited.
Do you plan to drive? Yes No
Do you plan to get a U.S. driver’s license? Yes No
Do you plan to buy a car? Yes No
Please discuss with your host family where you will park your car.
If you will not purchase a car, how far are you willing to walk or bike to get to campus? ____________
Are you comfortable using public transportation (buses, trains)? Yes No
Do you understand that ECC does not provide individual transport to and from the campus?
Yes No Sign here to indicate your understanding of these terms. ________________________
Lifestyle and Interests
Write brief comments on the topics below.
Your personality:
Work/career experience:
Travel experience:
Special interests and/or hobbies:
Page 7 of 8
What religion do you practice (if any)? _____________________________________________________
Are you willing to live with a host of a different religion than your own?
Yes No No Preference
Would you decline placement with a host of a specific religion? Yes No If yes, please specify:
Although we will do our best to match you with a family meeting your preferences, ECC cannot
guarantee placement with a family of a particular religion.
Do you have any medical or physical conditions? Yes No If yes, please explain:
Do you need any accommodations to live independently in a homestay (for instance: a homestay that is
adapted to a wheelchair)? Yes No If yes, please explain:
Do you have any psychological or emotional conditions that would affect your placement with a host
family? Yes No If yes, please explain:
Are you currently taking any medications? Yes No If yes, please list and explain:
Medication: ______________________________ Condition: ___________________________________
Medication: ______________________________ Condition: ___________________________________
Medication: ______________________________ Condition: ___________________________________
Medication: ______________________________ Condition: ___________________________________
Have you made arrangements, or plan to make arrangements, to have your medication filled in the U.S.?
Yes No
Do you have any special requests or needs your host family should know about? Yes No
If yes, please explain:
Page 8 of 8
What questions or concerns do you have about living with a host family?
Please include a letter of introduction and a current picture of yourself for your host family. Your letter
of introduction may include the following:
Details of yourself and your family
What you like to do in your spare time
Why you want to live with an American family
Describe your personality – do you like spending time alone or with others? Are you serious or
outgoing?
Any other information that may help your host family learn about you
Although all attempts are made to promote a positive and safe homestay experience, Elgin Community
College is not responsible for the lifestyle, schedule, behavior, philosophy, religious affiliation or
occupation of the homestay family. By signing below, I certify that I understand the above and give my
permission for any of the information contained in this form to be released to my homestay family and
have my housing information released to my parents, guardian and/or agent. I understand that once I
am assigned a host family, I am obligated to remain in the homestay for the duration of time as specified
in the Homestay Agreement.
Signature of Student: _____________________________________ Date: _______________________
(month/day/year)
Signature of Parent/Guardian: ______________________________
(if student is under 18 years of age)
_______________________
(month/day/year)
Date:
This form must accompany your Program Information, Policies, and Agreement for Full-Time
International Students for the ECC International Student Homestay Student Program in order for your
application to be processed.
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ISHP Full Time International Student Application Final (Elgin Community College)

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Completed 15 September 2020

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