| First
name: |
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Last
name:
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| Nickname: |
|
E-mail:
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| Gender: |
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| Birth
date*: |
month
day
year:
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| Area
you live in: |
|
| Phone*: |
(
)
-
|
| |
| How
long have you lived in the US: |
|
| Tell
us about your adjustment to life in the United States*: |
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| I
was born outside the US, but I am a US citizen*: |
Yes
No |
| Interests: |
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Spoken
languages:
FL — fluently; HC — can hold conversation; BT —
a little bit |
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| Countries
visited: |
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Countries
lived:
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