First Name:  Last Name:  UCI Student ID#:

UCI E-mail (must be valid): 

Local Phone:  Cell Phone: 

Gender: Age:

UCI Major:  UCI Minor/Second Major: 

UCI class standing as of this fall:

Graduation date:

Have you gone abroad on EAP or IOP? (check one) Yes: No, but I will be going abroad in the future:

I have participated/will be participating in the following CIE program(s) (use as many as needed):

EAP or IOP:  Country: Program/Term: 
EAP or IOP:  Country: Program/Term: 
EAP or IOP:  Country: Program/Term: 

Would you like to be assigned a student from the country you’ve returned from or will be going to? Yes: No

Which country(ies):

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?

Would you be interested in mentoring more than one EAP Reciprocity student?

Is there any else that you think would be helpful for us to know in matching you with an EAP Reciprocity student?