Interchange Home Visit Form
(to be filled out before selection for Interchange Programme)
DATE:
INTERVIEWER:
IC REFERENCE NO.:
APPLICANT NAME:
PARENT NAMES:
IC PARTNER CHAPTER AND COUNTRY:
1. What sleeping accommodations will be provided for the partner delegate? Can the visiting
delegate have his/her own room?
Note: As a minimum, the visiting delegate must have his/her own bed.
2. What expectations do the parents have of the partner delegate with respect to house rules and
chores?
Rules=curfew, local phoning, home phoning, punctuality, attendance at religious services, etc.
Chores=kitchen duties, making beds, cleaning up, laundry, yard work, etc.
3. Do the parents agree with Interchange guidelines to limit the use of computers and telephones
for both host and visiting delegate during the programme?
Note: Interviewer should review the recommendation to give delegates limited contact with their parents and friends
back home during the travel phase. Too much communication can foster homesickness and interfere with the activities
in the partner country.
4. Did you meet the siblings? How many? Your impressions?
5. Note the ambience and general atmosphere of the home.
6. Note the general attitudes and behavior of all family members.
1
Interchange Home Visit Form
(to be filled out before selection for Interchange Programme)
7. Which adult will be home during the day when the host delegate and visiting delegate are not
involved in CISV activities?
8. Would you, the interviewer, place your child in this home for an Interchange? If no, why not?
9. Do you have concerns about this family? If so, what are they?
10. Please use this space to note any additional observations or to make other comments.
2