Pitt PAL Request Page

First Name:

Last Name (Family Name):

Nickname or English name you are called:

Student ID:

Age:

Gender

Female Male

I am currently:

An Undergraduate Student
A Graduate Student
An Intensive English Program Student (IEP)

Street 1:

Street 2:

City:

State:

Select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code:

Home Country:

Phone Number:

E-mail Address:

I am:

An INTERNATIONAL student seeking a local Pitt State Pal
A DOMESTIC student seeking an international Pal

In order to contact me, I want my Pal to receive my:

E-mail Address Phone Number

Countries You Are Interested In:

What is your major course of study?

I consider myself to be a

Social person Academic person Cultural person

Please elaborate:

Please list your hobbies, interests, extracurricular activities, clubs or organizations:

Do you have a religious affiliation?

Yes No

Do you smoke?

Yes No

Please make any additional comments: