First NameLast NameBirth MonthBirth DateBirth YearGenderGender OtherPrefer be matched with the same genderEmailBanner IDPhoneNationalityCitizenshipMajorStudent StatusLanguages SpokenLanguages StudyingHas Traveled abroad toPastParticipationHobbies and Special InterestsAdditionalInfoAgreementJanFebMarAprMayJunJulAugSepOctNovDec01020304050607080910111213141516171819202122232425262728293031MaleFemaleTrans*OtherYesNoAmericanInternationalUndergraduateGraduateHonors CollegeALIYesNo I Agree 0 and contains($uri,'&LangType=-1')"> function ektLocalizeDate(date, id) {setTimeout(function() {if (document.getElementById && 10 == date.length) {var oTempDate = new Date(date.substr(0,4), parseInt(date.substr(5,2),10)-1, date.substr(8,2));document.getElementById(id).innerHTML=(oTempDate.toLocaleDateString ? oTempDate.toLocaleDateString() : oTempDate.toLocaleString());}}, 1); }//  Thank you for applying for Conversation Partners. We will be in touch soon!" />

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.