First Name: *

Sex: Male Female *

Age: *

Phone: ( ) -

E-mail: *

UT Status: Undergraduate Graduate Faculty Staff ESL Alumni Visiting Scholar Other (please explain)

Marital Status: Single Married *

Major:

Classification: 1st year 2nd year 3rd year 4th year Graduate Other / not applicable

Country of Origin : *

Native Language(s) : *

Dialect (if applicable)?

Length of time in the U.S. : *

Language(s) you would like to practice:

First Preference:

Second Preference:

If my language preference is NOT available please match me with a PAL from ANYWHERE in the world.

Have you previously requested a PAL Yes No Yes, but I wasn't matched .

Interests and hobbies: *

If possible I would you like more than one PAL

Would you be comfortable with a PAL of the OPPOSITE gender? Yes No *

Other specifications:

How did you hear about the PALS Program: -- Friend International Office Website Ad on Daily Texan Attented a PALS activity Flyers on campus Other