English-In-Action (EIA) Partner Signup Form
Thank you for your interest in our program! We are a volunteer effort sponsored by YWCA Berkeley/Oakland.  We pair up English speakers with English learners who seek to improve competency in the English language through casual conversation.

For over 50 years, EIA has proudly served UC Berkeley international scholars/students and their family members. However, starting this semester, we are restructuring our services and will be primarily focused on supporting asylum seekers, recent immigrants, and university service workers whose first language is not English.  

If you do not fall into these 3 categories, you're still welcomed to fill out the registration form so we could redirect you to programs/resources that might be helpful to you.

Please note that this registration form contains demographics info that we will utilize for data collection to help us understand and track the populations we are serving. All questions are optional and answers are kept anonymous.

Thank you,
Karen Lei
YWCA Berkeley/Oakland EIA coordinator
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Title
Clear selection
Family/Last Name *
First Name *
Email Address *
Phone Number (Pls put down a US phone number) *
Mailing Address *
Status (This allows us to access your needs and eligibility) *
If you answered "Other" above, please briefly describe yourself and reasoning for applying to EIA. We will get back to you if we have resources that match your needs. 

For example: Visiting Scholar in Law, PhD in Math, Exchange Undergraduate, etc, looking for opportunities to speak English, or need to pass OPT exam, etc.
Home Country *
What is your native language?
Date Arrived in USA *
MM
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DD
/
YYYY
Approximate Departure Date from USA (if applicable)
MM
/
DD
/
YYYY
Hobbies, interests *
Meeting format (check all that you are comfortable with) *
Required
How did you hear about EIA? *
EIA Objective #1: Rate your confidence in speaking English *
Not confident at all
Very confident
EIA Objective #2: Select your English language proficiency level
 *
EIA Objective #3: Select reasons why you choose EIA
 *
Required
YWCA Statistics #1: Ethnicity *
Required
YWCA Statistics #2: Age *
YWCA Statistics #3: Gender *
YWCA Statistics #4: Do you identify yourself as part of the LGBTQ+ community?
Clear selection
YWCA Statistics #5: Household Income (annual)
Clear selection
YWCA Statistics #6: Which community do you live in?
Clear selection
YWCA Statistics #7: Zipcode
Any questions?
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