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INTERNATIONAL
STUDENT INFORMATION SHEET
Date
___________
Name: _______________________ __________________________ Male _____ Female _____ Age
_______
(Given Name) (Family
Name)
Married
____ Single _____ If
you’re married, is your spouse with you? Yes
_______ No
________
What
is your spouse’s name? ____________________________ __________________________________
(Given Name) (Family
Name)
What
are your children’s names and ages?
____________________________________________________________________
Country
of Citizenship: ____________________________
Email
address: ___________________________________
Address:
_______________________________________________________ Zip:__________
Home
Telephone Number: ___________________________ Cell
or Work Telephone Number: ____________________
Undergraduate
_____ Master
_____ Ph. D. _____ Visiting Scholar ____ Spouse of student
____ Other ________
Major subject of study/job:
__________________________ How
long have you lived in the
How
long will you live in
When
are you available to take classes? (Ex: M, T, W, Th,
F, Sa, Su; AM, PM) –Please write your schedule on the back.
What
would you like do during your English class time?
_________________________________________________________
In
order to develop your English, which of the following are you interested in
improving:
speaking
_____ listening
_____ reading ______ writing ______ other,
please list______________
What
are your hobbies and interests? ________________________________________________________________________
Which
activities would you like to do at the Chapel?
Bible
study ____ Conversation
class _____ Cooking
class _____ TOEFL
class _____
Quilting
group ____ Outings
to places of interest _____ Sports
activities _____ Sunday
Worship ____
Cook
for dinners ____ Help
set up for dinners _____ Conversation
partner_____ Other,
please list ______
What
do you think your English conversation level is?
____
Beginner: I speak a little English, usually in short simple sentences.
It is difficult for me to have a conversation with Americans
because I do not know a lot of vocabulary. I am very nervous to speak English.
____
Average: I speak some English, usually in complete sentences with some
difficulty in grammar and pronunciation. If I took a TOEFL test, I would pass
or
be very close to passing. I am a
little nervous to speak English.
____
Advanced: I speak English often; I can have conversations with Americans
about many topics. I passed the TOEFL
.
How
did you hear about this program?
_______________________________________________________________________
Please
return to: PLACE YOUR CONTACT INFORMATION HERE.
Everyone is welcome to join the classes and activities
regardless of religious beliefs. The English teachers use the Bible as a
teaching tool for
our English conversation groups.
Please talk to the director with any questions or concerns.