Conversation Partner Application

 Personal Information

Name

 

Exact Mailing Address

(As it should appear on
mailing label)

 

E-mail Address

 

Area Code & Phone Number

 

Gender

 

Country of Birth

 

Cultural Affiliation

 

How long have you lived in the US?*

 

Languages you speak and level of proficiency:

 

 

Availability

What is the best time to meet on a weekly basis?

 

Day(s)

To select multiple days, hold down the CTRL key and then use you mouse to select each day you are available

 

Time(s)

To select multiple days, hold down the CTRL key and then use you mouse to select each day you are available

 

 

Partner Preference

What gender partner do you prefer?

 

 

For Students

School & Field of Study

 

Level of Study
(BS, MS, PhD)

 

Anticipated Granduation Date

 

 

For Post Docs and Visiting Scholars

School & Field of Study

 

Departure Date

 

 

For Employees

Department

 

Position

 

 

     

 

Last modified: Aug 01, 2013
ID=x13909