Please submit this form to Foreign Student and Scholar Services,... APPLICATION UM



OFFICE USE ONLY ____/____/____

Please submit this form to Foreign Student and Scholar Services, Lommasson Center 219, U of M, Missoula, MT 59812 (Phone:

243-2226, Fax 243-6115) before the end of the semester. Information from this form will be used to match you with a foreign student. Please feel free to use the back if more space is needed. After we receive this form, we will contact you with further details. Thank you for your interest!

Name: _________________________________________________________________Gender:___________ Age_________

Present School Level: ____Freshman ____ Soph. ____ Junior ____ Senior ____Grad UM ID : ___________________________________

Field of Study: Major ____________________________________________ Minor___________________________________

Other Academic interests: ________________________________________________________________________________

How long have you been a student at UM? _________Years Expected date of graduation:________________________

Religious affiliation (if applicable):

1. Cross-cultural experience, if applicable (e.g. living/traveling abroad, foreign languages, study of another culture, etc.):

2. In which ways do you think you could contribute as a global partner to a foreign student?

3. Please list your hobbies and interests. (This will help us match you to your student.):

4. Additional comments:

5. Do you have a specific country/geographic area request? _____________________________________________________

* Many of our students come from Japan, and other Asian countries, and a few from European countries. The rest of the new students might represent an additional 15-20 countries, with 1 or 2 students each. We get very few students from Africa, Middle and South America, and the Middle East. Please keep this in mind and be flexible if you can.

6. Are you willing to accept a student from any country if your preference cannot be matched? _______Yes _______No

7. Would you be willing to serve 2 students if there is a shortage of partners? _______Yes _______No

8. Please identify two references, their relationship to you, and their phone numbers:


2. _____________________________________________________________________________________________





Current Phone ____________________________

Current Fax (if you have one) ________________

E-Mail Address:____________________________

Is E-Mail a good way to reach you?___Yes ___No

....... Also during the break?___Yes ___No


: What is your VACATION contact information so we can contact you during break!

E-Mail (if different) ____________________________________________________________Phone_____________________