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* indicates required fields
*Family Name:
*Given Name:
English Name:
*Address:
Phone Number:
*Email Address:
*Gender: Male Female
Birth Date:
Home Country:
Languages Spoken:
Grade/Level: NUIS Freshman (Year 1) Sophomore (Year 2) Junior (Year 3) Senior (Year 4) Graduate (Year 1) Graduate (Year 2)
When did you arrive in the US?
When did you arrive in Maryville?
Are you an exchange student? Yes No
How long is your program?
When do plan to graduate?
Are you married? Yes No
Name of spouse:
Is your spouse living in the US? Yes No
Do you have children? Yes No
List your children's names and ages:
Where are your children living?
List any foods you dislike or cannot eat (religious reasons or allergies):
List hobbies and interests:
Select 1 for your first preference, 2 for second, etc. While every attempt will be made to match you with a Friend who shares your interests, your preference cannot be guaranteed.
No Preference - Select - 1 2 3 4
Single Friend - Select - 1 2 3 4
Friend without children - Select - 1 2 3 4
Friend with children - Select - 1 2 3 4
Are you allergic to animals? Yes No
Which animals?
*Would you prefer to be matched with a friend with? No Preference Friend with cat Friend with dog Friend with any pet Friend without pets
Do you have use of an automobile? Yes No
List other information that might be helpful in matching you with a Friend.
Agreement
*Legal Signature:
