Conversation Partner Request Form

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Please fill out form completely

Name Name * First Last
Banner I.D. *
Maximum of 9 digits allowed. Currently Entered: 3 digits.
Brockport Email (requests without a valid Brockport email address will not be fulfilled) *
Phone (optional) Phone (optional) - ### - ### ####
What year are you in? *

What year are you in? -- No more choices left --
What is your academic major? *
What languages do you speak? *
Tell us about yourself (academic interests, hobbies, culture, etc.)
What are your goals? Check all that apply. *

What are your goals? Check all that apply. Sharpen English proficiency to improve learning in English Become more comfortable participating in class discussion Become a more effective presenter Improve informal conversation skills Improve pronunciation and fluency Engage in cultural exchange Other Other
When are you available to meet with a Conversation Partner?

ASC Tutoring Hours
Mondays-Wednesdays 8am-8pm, Thursdays-Fridays 8am-5pm

Please list provide the days and times that you are available.

Please put an 'X' for any days for which you are not available.
Monday *
Tuesday *
Wednesday *
Thursday *
Friday *
How often would you like to meet with a Conversation Partner? *

How often would you like to meet with a Conversation Partner? Just once for now Once a week
Thank you for your interest in the Conversation Partner Program. An ASC Tutoring staff member will reach out to you soon.