Home Hospitality Host Application
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1 Home Hospitality Host Application UCCD Program Director Ms. Deeanna Price (801) Welcome to the Utah Council for Citizen Diplomacy (UCCD). We are delighted to have you as a new Home Host! Home Hospitality is an opportunity for you to invite a group of up to 4 International Visitors from around the world and their interpreter to your home for dinner and conversation. The guests spend a few hours at your home having a meal with you, your family and your friends while having an open discussion about American lifestyle, culture, and customs. Hosting opportunities are listed in UCCD s bi-monthly e- newsletter. Our Visitors are looking forward to getting to know you and spending time with you and your family! The International Visitors you will be hosting are current or emerging leaders from across the world who come to the U.S. on the Department of State s International Visitor Leadership Program (IVLP). While in the U.S., they meet with professional counterparts and visit U.S. public and private sector organizations related to their field of interest. International Visitors typically travel to four U.S. communities over three weeks, although projects vary based on themes and Embassy requests. Participants travel alone, with others from their home country, or they may be in a group of all different nationalities, depending on the theme. We appreciate your generosity in offering to open your home to International Visitors! This opportunity is meant to build the relationship between you and your guests, reinforcing long-lasting relationships and a better understanding of one another s countries, culture and viewpoints. Please include the requested information in the application below. Feel free to contact a Utah Council for Citizen Diplomacy staff member with any questions or concerns. Best wishes, Deeanna Price Events Coordinator Home Hospitality Host Application Page 1
2 COMPLETED APPLICATIONS MUST BE RECEIVED NO LATER THAN FIVE BUSINESS DAYS PRIOR TO YOUR FIRST HOSTING DATE Instructions for completing this application: 1. Please sign up as a UCCD member to be eligible for Home Hospitality. Membership is free and open to all! 2. Please fully complete all sections of this application in order to be considered for the program. 3. Please include a short narrative biography for you and your family that we can share with the Visitors prior to the hosting date. We have found that this background information helps Visitors and Hosts discover similar interests and paves the way for lively conversation. 4. Home Hospitality is powered by volunteers and our Home Hosts are responsible for transportation to and from the Little America Hotel. As a new home host, we kindly ask that you electronically sign and date the Proof of Insurance Letter provided at the end of this application and provide a copy of the first page of the driver s car insurance policy. 5. In order for UCCD to share your Home Hospitality photos and stories with our members on our website, in our newsletter and on social media, please electronically sign the Media Consent and Release Form provided at the end of this application. 6. Each adult household member (18 and over) must fill out and sign the Background Check Disclosure and Authorization Form provided as a separate document on the Home Hospitality page of UCCD s website. You may return the signed forms by traditional mail, or fax. We appreciate your understanding of this Department of State requirement. At UCCD, we take the safety of our members and International Visitors very seriously. Home Hospitality Host Application Page 2
3 Application Check List: Please download, fill out electronically, and to Deeanna Price at or mail it to: Utah Council for Citizen Diplomacy Attn: Deeanna Price 1840 S 1300 E Salt Lake City, UT Completed application Family biography Signed* Proof of Insurance Letter Signed* Media Consent and Release Form Once we have received your application, a representative from UCCD will contact you to review your application, start a background check, and answer all your questions. Home Hospitality Host Application Page 3
4 Name of Host(s): Additional Household Members? Address: City: State: Zip Code: Home & Cell Home Phone: Phone Numbers: Cell 1: Cell 2: Addresses: Pets? How many? What type(s)? Foreign Languages? Who? What language? Countries/regions of Interest: Hobbies and Interests Professional Interests Home Hospitality Host Application Page 4
5 What inspired you to become a Home Hospitality Host? Have you ever hosted a foreign guest, youth or adult, in your home? If so, please elaborate. How many guests can you comfortably accommodate? In your home? In your vehicle? Would you be open to hosting a Visitor(s) with a disability? If so, is your home wheelchair accessible? Is your vehicle wheelchair accessible? Home Hospitality Host Application Page 5
6 Please include a short narrative biography for you and your family that we can share with the Visitors prior to the hosting date. We have found that this background information helps Visitors and Hosts discover similar interests and paves the way for lively conversation. Home Hospitality Host Application Page 6
7 Proof of Insurance Letter UCCD s insurance carrier company requires that we obtain a copy of your auto insurance in order for you to transport visitors to and from the hotel. Please attach a copy of your auto insurance policy, showing the effective dates and limits of liability (typically 1st and 2nd page of your policy). Your cooperation is much appreciated. I hereby confirm that I am in possession of a valid, full coverage auto insurance policy. The purpose of this testimony is to provide the Utah Council for Citizen Diplomacy (UCCD) with proof of insurance coverage in order for UCCD to be able to produce such proof for future legal and insurance purposes. Signed: Salt Lake City, UT Date: / / Policy Holder's Auto Insurance Carrier: Print Policy Holder's Name: Policy Holder's Address: Policy Holder's Phone Number: ( ) - Policy Holder's Signature: Date: / / Home Hospitality Host Application Page 7
8 Media Consent and Release Form I,, in connection with the Utah Council for Citizen Diplomacy (UCCD) Home Hospitality program, hereby authorize UCCD to use my image and/or words in connection with the Home Hospitality program and International Visitor Leadership Program. Additionally, I hereby authorize the Utah Council for Citizen Diplomacy to release, publish, or quote such material, including my name, for promotional purposes including on UCCD s website, in social media and in printed materials without further notice. Such authorized usage includes news reporting, selfpromotion and fundraising, but excludes direct commercial use. I understand that I may decline to give my consent (by not signing this form) and still continue to participate in Home Hospitality activities without being disadvantaged with respect to those activities. Host s Signature Date Printed Name Home Hospitality Host Application Page 8
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