3 Contact Information .pdf


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CONTACT INFORMATION (Address and Host Family Information)
Per J-1 visa requirements, Amity must have your U.S. address at all times. We must update your information within 3 days of moving.
Please provide the requested contact information in the section below. If you are staying in a dormitory, provide your mailing address and
telephone number.
Name of Intern:

Name of School:

City and State of School:

Date:

CARLO Manon

LNFI L'Etoile du Nord

Saint Paul, MN

28/11/2012

First Host Family:
From ( Month/Day/Year):

To ( Month/Day/Year):

First and Last Name of Host Parent (1):

First and Last Name of Host Parent (2):

12

Krysia Weidell

Cliff Weidell

Street Address:

City:

State:

Zip Code:

2093 Lacrosse Avenue

Saint Paul

MN

55116

08

/ 25

/ 2012

/1

/ 2012

Email Address: krysia.weidell@pacelabs.com

Telephone Number: ( 651

) 795-1595

Second Host Family:
From ( Month/Day/Year):

To ( Month/Day/Year):

First and Last Name of Host Parent (1):

First and Last Name of Host Parent (2):

12

01

Tami Maddio

Michael Maddio

Street Address:

City:

State:

Zip Code:

1136 Hawthorne Avenue

Saint Paul

MN

55117

/1

/ 2012

/ 18

/ 2012

Email Address: tamimaddio@gmail.com

Telephone Number: ( 651

Third Host Family:
From ( Month/Day/Year):

To ( Month/Day/Year):

First and Last Name of Host Parent (1):

04

06

Deidre Greene

/ 06

/ 2013

/ 16

/ 2013

) 428-6143

First and Last Name of Host Parent (2):

Street Address:

City:

State:

Zip Code:

1753 Yorkshire Avenue

Saint Paul

MN

55116

Email Address: deidre.greene@gmail.com

Telephone Number: ( 612

) 719-5233


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