Conversation Partners Application


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    Your Birth Date

     

    ,

     
    Gender
              

    (Optional)   

    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?
          


     

    (Optional)
     

    Agreement

    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.