International Student Profile

First (Given) Name:

Middle:

Last (Surname):

Home Address (as it must be written for you to receive international mail):

Phone Number:

E-mail:

Age:
-Choose- <15 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 >35

Birthday:
- Month - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Year - 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965

Gender:
Male
Female

Is this your first time at an American university?
Yes
No

Are you studying in the United States now?
Yes
No

If yes, name of university or high school you are currently attending:

When will you begin your study at UW-Eau Claire?
Month:   Jan Sept Year   2006 2007 2008 2009 2010 2011 2012 2013

How long will you study at UW-Eau Claire?
Semesters:   1 2 3 4 5 6 7 8 >8 or
Years   1 2 3 4 >4

Do you intend to earn a degree from UW-Eau Claire?
Yes No

Intended area of study at UW-Eau Claire:

Are you on an exchange program?
Yes No

If yes, name of the program (home university or program name):

Will you be a student in the English Language Academy (English as a Second Language) program?
Yes No

Class standing at time of admission to UW-Eau Claire:
Freshman
Sophomore
Junior
Senior
Graduate

Educational Background (area of study, degree earned):

Countries traveled in:

Languages spoken:

Please tell us about yourself - hobbies, interests, family, future goals, etc. This enables us to better match you with a host family.

Host family/friends vary in size of family, religion, pets, interests, etc. Although we will honor your preferences if we are able, please note that we cannot guarantee placement in requested preferences.

When you arrive in Eau Claire would you like to stay with your host family/friend before you move into the residence halls? Please note that the residence halls will most likely not be open the weekend you arrive.
Yes
No

Please list any health concerns, dietary concerns, allergies (pets, smoke, etc.):

Do you smoke?
Yes
No

If yes, would you agree to smoke only outside? (Many hosts do not allow smoking in their homes.)
Yes
No

Would you mind staying with a host friend who smokes?
Yes
No

Host friends vary from single individuals to families. Please check below if you have a preference.
Single person or small household
Multi-person or large household
No preference

Will you stay with a host who has pets?
Yes
No

Religious affiliation (optional):

Is it important to you to be matched with a host of similar religious affiliation?
Yes
No