1. NAME:    ________________________________

2. PHONE #:  _______________________________

3. DORM & ROOM #:  ________________________

4. E-MAIL ADDRESS:  ______________________________

5. STATE (US)  or NATIVE COUNTRY:  _____________________________

6. LANGUAGES:
         fluent (in spoken/written form):   ____________________   reading command:   ____________________

7. EDUCATION:
         Please indicate the highest level completed: __________________

8. SPECIAL EXPERTISE/SKILLS/TALENTS—Check all that apply.

           Other (Please specify.): ____________________________________________________

9. MAJOR at the university:  ___________________________

10. CAREER GOAL:  ___________________________