Ukraine Host Form Name Email Address Phone Address Languages Spoken Gender Type of unit Type of unitFurnished RoomApartment in buildingBasement ApartmentTownhouseSeparate unit in main houseOther: Host's Status Host's StatusOwner of unitTenant of unitOther Rooms Available Rooms AvailableOneTwoThreeMore Bathrooms Available Bathrooms AvailableOneTwoThreeMore Entrance EntranceSharedSeparate Meals MealsIncludedNot IncludedPartially Included Hosting Term Hosting TermOne MonthThree MonthsSix MonthsOther How many family members live at home How many family members live at homeOneTwoThreeFourMore than four Are you willing to have a home visit by CCI Are you willing to have a home visit by CCIYesNo Are you willing to obtain a Vulnerable Sector Check (Required for host matching program) Are you willing to obtain a Vulnerable Sector Check (Required for host matching program)YesNo Additional Comments 13 + 10 = Submit
