Study Abroad

First Name:

Family Name:

Date of Birth:

Gender: M     F

Sam ID:

Country of Citizenship:

First Language:

How many university-level Foreign Language courses have you taken?

Contact Information

Local Address:

City:

State:

Zip Code:

Email Address:

Phone Number:

Personal Information

School Classification:

Academic Major:

Hobbies:

1)
2)
3)

Other Interests (activities you enjoy participating in): 1)
2)
3)

Name 3 things you like to do with friends on the weekend: 1)
2)
3)

Are you involved in any clubs or extracurricular activities?
Yes
No

If yes, please list the clubs and extracurricular activities here:

Would you prefer a Buddy from a particular country/region?
Yes
No

If yes, please list:

Why do you want to participate in the Buddy Program?

Do you drink alcohol?
(US law prohibits alcohol consumption of persons
under the age of 21)
Yes
No

Do you smoke? Yes
No

Do you have your own transportation? Yes
No

If yes, would you be willing to occasionally drive your Buddy to the grocery store or to other shopping areas?
Yes
No

Cultural Ambassador - Code of Conduct Agreement

I agree that for the duration I am in the Cultural Ambassador program, I will abide by the guidelines listed below. I further agree that I understand that if these guidelines are not followed, it could result in my expulsion from the program, and being barred from further participation. These are the guidelines I will adhere to:

• I will not initiate or invite any sleepovers with my Buddy.
• I will not engage in any activities that are considered illegal by the U.S. or the state of Texas while in the presence of my Buddy.
• I will not allow my Buddy to drive any vehicle, unless they have a valid U.S. Driver's License.
• I will conduct myself appropriately and professionally in all interactions with the students and OIP staff.

I AGREE

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