Application

First Name:
Last Name:

I am Male Female

I am an English learner. a faculty or staff member.

If a student, which program?

  • IIEP
  • TAPE
  • ESL Credit Classes
  • None (Non-native speaker not taking an ESL class)

If faculty or staff, which department?

What is your English proficiency?

  • Native Speaker
  • Near Native
  • Other:

Campus Address:



Iowa City, Iowa 52242

Local Address:



, Iowa
 
E-mail address:

(Enter the address you use most often.)
Daytime Phone:

1. Briefly, why do you want to have a conversation partner?

2. What five words best describe you?

3. What are some of your activities or hobbies?

4. What is your (intended) major or profession?

5. How did you find out about this program?

6. We will try to pair you with a partner of your gender. However, if we cannot find one, will you accept a conversation partner of the opposite gender? (It's okay to say NO; it won't decrease your chances of getting a partner.)

Yes, I will accept a partner of the opposite gender.

No, I prefer a partner of my own gender.