This form is to be filled out ONLY by students attending the Intensive English Program (IEP) at Memorial.

Conversation Partner are required to meet for a minimum of one hour a week (a minimum of 10 hours during the semester).

Because this program relies on volunteers, we cannot guarantee a partner for all who apply.



Today's date (dd/mm/yyyy)


Your Family Name


Your Given Name


You are
male
female

What gender do you want your partner to be?
male
female
either

Your age will help us match you with someone close to your age.

What is your age?


We will give your phone number and email address
to your partner.

What is your phone number?


What is your MUN email address?


You are a ...
new student
returning student

Have you had a conversation partner before?
yes
no

Core Teacher's Name


What are your favourite activities?



What time is your listening/speaking class?
1:00
3:00
no class
I don't know.