Language Interchange Program (LIP) Application

*Please note that not every applicant is guaranteed a partner. The number of pairings will depend on the number of students that sign up.

First Name: *

Last Name: *

Gender: *

Male

Female

Student Number: *

Home country: *

Email Address: *

Program Attending at Brock: *

Year of Study: *

Other:

language(s) you can provide: *

language(s) you want to improve: *

Hobbies/Interests/ Special Requests:

Brock University Niagara Region 500 Glenridge Ave., St. Catharines, Ont., L2S 3A1 Canada

Telephone: 905-688-5550