CCIS English in Action Application Form

Please fill out the whole form to provide your contact information and to let us know your interests and preferences.

When you’re done, click the Submit Changes button at the bottom. Thank you!


Click here to discard changes
or return without making any changes:

I am a Grad Student Visiting Scholar Post-doc Spouse
Last Name First Name Greeting you prefer to follow the word 'Dear'
You: Dear 
Spouse/Partner:
Street Address City State ZIP
Phones: Home Mobile Other
Email:

Please provide your gender and approximate age:
 I am: female male.         20-29 30-39 40-49 50+

Do you have children with you in the US? Yes No
    If yes, please list their names, gender (M/F), and year of birth, one per line
    e.g., Johnny, M, 2007:

Most of our volunteers find it too difficult to converse when small children are with you during the conversation time.
We strongly recommend that you have someone else care for your children during your weekly conversation time.
Can you do that?: Yes No

Your preference (if any) for the gender of your conversation partner: Male Female

Tell us about your interests!
Art Dancing Film Food/Cooking Games Gardening
 Hiking  Music Playing/Performing Music Photography Reading
Shopping Sports Technology Television Travel Writing
Other Interests, or details (e.g., which sports?)

Home Country:

Occupation or Job Experience:

Major Field of Study:

Department affiliation at Stanford (yours or spouse's):

You expect to be available for EIA through the month of (use YYYY-MM format, such as 2020-12):

What times might you be available to meet a conversation partner?
Weekdays   Weekends   Evenings  
Are you able and willing to drive off campus to meet with your partner? Yes No

Are you taking English classes? Yes No

If you have any questions about English in Action or other CCIS programs, please email EIA@CCISstanfordU.org.