CCIS English in Action Application Form for Internationals

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 
Street Address City State ZIP
Phones: Home Mobile Other

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:

To get the most benefit out of your English conversation, we strongly recommend that you have someone else care for your children during your weekly conversation time.
Can you do that?: Yes No

Do you have a preference for the gender of your conversation partner?
I want a female partner
I want a male partner
Either male or female partner is OK

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?)

Country of Origin:

Your Occupation or Job Experience:

Stanford Department Affiliation (not applicable for spouses):

How long will you be at Stanford?   From the month of to the month of
(use YYYY-MM format, such as 2020-12, for each date)

How do you wish to meet your conversation partner?
In person   Remotely (Zoom, etc.)

What times might you be available to meet a conversation partner?
Weekdays   Weekends   Evenings  

What transportation would you use?
Walking   Biking   Public transportation   Driving my car  

Are you taking English classes? Yes No
If Yes, where do you take classes?

If you have any questions about English in Action or other CCIS programs, please email