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Featured Services
Safe neighborhoods
Warm loving families
A private bedroom
Internet Access
A shared bathroom
Two meals daily
New! Homestay
Immersion Program!
Contact Us
848 North Shore Road
Revere, Mass. 02151
Phone: 781-307-3039
Fax: 617-728-4299
E-Mail:
WelcometoAmericahomestay
@gmail.com
 
Application For Homestay

Welcome to America Homestay
848 North Shore Road Revere, Mass. 02151
Phone: 781-307-3039

There is a one time non-refundable application fee of $200.00.
 
 
Name
 *
Email
 *
Telephone:
 *
Mailing Address:
 *
City:
 *
State:
 *
Postal Code:
 *
Sex:
 Male Female
Date of Birth:
 *
Home City :
 *
Religion:
 *
In your country are you a student or working? If you're a student tell us what your university and major subject is. If you're working, what is your company and your job?
Is this your first time to live the U.S:
 Yes No
If no, where and when did you live:
Length of Homestay(Week):
Others (please specify) :
Please check ALL items below that describe you:
shy friendly curious quite cheerful serious humorous
social
Others (Please Specify):
What activities do you enjoy?
studying dancing movies reading watching TV shopping
museums hiking sports
Others (Please Specify):
What type of movies do you enjoy?
action romance comedy drama Suspense
Others (Please Specify):
What type of music do you enjoy?
classic rock jazz country popular alternative
Others (Please Specify):
What kinds of books do you like to read?
non-fiction science fiction mystery classics poetry romance
newspapers
Others (Please Specify):
What qualities do you value in others?
loyalty kindness sense of humor patience intelligence honesty
Others (Please Specify):
What kinds of foods do you like? :
Are you a vegetarian? :
 Yes No
Do you smoke? :
 Yes No
Would you prefer living with small children (under age 6)? :
 Yes No Either
 
HEALTH INFORMATION
What is the condition of your health? :
 Excellent Good Fair
Poor
Do you have any medical condition(s)that require special treatment? :
 Yes No
If yes, explain :
Are you allergic to pets? :
 Yes No
Are pets okay in your homestay? Yes No
Why do you choose HOMESTAY?
 
ADDITIONAL CONSIDERATIONS (include information about yourself that you would like your host family to know)
 
Signature of applicant Date: