Western Illinois University: Macomb Campus

Current Semester

Name

Local Address

Local Phone Number

WIU Email Address

Age

Sex
Male Female

Major

If you are a student, Choose a year
Freshman
Sophomore
Junior Senior Graduate Not Student

List your Interests/Hobbies

Are there any countries you specifically interested in learning about?  If so, what are they?

Have you ever been a conversation partner before?
Yes No

If yes, would you like the same partner?
Yes No

What is the person's name?

If yes, can we assign you a partner of opposit sex?
Yes No

Are you more interested in meeting with your partner in a small group setting?
Yes No

If yes, and there is a specific US student you’d like in your group, who?

Please fill in your class and work schedule