Conversation Partners Application


    Your Birth Date





    Would you prefer to be matched with someone of the same gender?

    (Must be IUP e-mail address)


    (If no phone, type 555-555-5555)

    I am:



    Student Status




    Have you participated in Conversation Partners in the past?




    As a member of Conversation Partners, I agree to:

    • meet with my partners at least one hour per week
    • contact the Conversation Partners coordinator if I have any concerns
    • allow photos of me to be used for promoting Conversation Partners

    By checking the box below, you are agreeing to the terms listed above.