Student Request for International Friend

UO Student ID Number:

Gender: Male Female

Name:

Home Country:

Date of Birth:

Visa Type(F, J, Etc.):

Eugene Address:

Zip Code:

Local Phone #:

E-Mail*:

*Important If you do not have an e-mail address, please type "none," otherwise the form will not be sent.

Student Information

Graduate Undergrad Visiting Scholar

Field of Study or Research:

Date of Arrival at the UO:

Date of anticipated permanent departure:

Countried traveled:

Languages spoken:

Any food restrictions or other allergies?

Occupation or business (student, etc.) in your home country:

Do you smoke? Yes   No     Religion (optional):

Other interests, hobbies, or leisure time activities:

Single   Married   Spouse Here?

His/Her Name:

Speaks English?

Children (if any)?

Name, gender and ages of children: