First Name:  Last Name:  UCI Student ID#:

E-mail (must be valid): 

Gender: Age:

Home Country: Home University:

UCI Major:  UCI Minor/Second Major: 

UCI class standing as of this fall:

What languages can you speak (other than English)?

Would you like to be assigned a student who can speak the same language(s)?

List your hobbies and interests:

Do you want to be assigned a student who shares similar hobbies or interests?

Describe what you would like from a Mentor:

Is there any else that you think would be helpful for us to know in matching you with a UCI student?