English-In-Action (EIA) Partner Signup Form

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Thank you for your interest in our program! We are a volunteer effort sponsored by YWCA Berkeley/Oakland. We pair up native English speakers with with UC Berkeley students, visiting scholars and their partners, students from adult school and local community colleges, as well as community members, who seek to improve competency in the English language. There is no formal English instruction--just casual conversation.

The commitment is one hour a week and meetings are usually held in-person or online, based the preferences/needs of the volunteer and the partner.

EIA YWCA Annual Program Fee is $30.

Please fill out the form and we will reach out to you to let you know how to pay and setup a 15-min orientation with the EIA team to help us better match you to an available volunteer.

NOTE: EIA Office Hours are Tuesdays and Thursdays 9am-2pm. We have limited office hours and will communicate and coordinate with you during this time. Thank you for your patience.

Thank you,
Karen Lei
YWCA Berkeley/Oakland EIA coordinator

Title *

Mr.

Mrs.

Ms.

Family/Last Name *

First Name *

Email Address *

Phone Number (Pls put down a US phone number) *

Mailing Address *

Status *

UC Berkeley Visiting Scholar/Researcher

UC Berkeley Graduate student

UC Berkeley Visiting Graduate student (Visiting PhD)

UC Berkeley Undergraduate student

UC Berkeley Visiting Undergraduate student (Exchange)

Spouse of UC Berkeley Visiting Scholar/student

Berkeley Adult School student

Student from other college/university

Community member

IRC Client

Other:

If you answered "Other" above, please indicate your status. If you answered "Student from other college/university, please indicate which one. If you have answered "IRC Client", please put name of your case worker and their email address (otherwise put N/A) *

UC Department/Major and Level (ie. Economics major, Freshman) *

Home Country *

Date Arrived in USA *

YYYY

Approximate Departure Date from USA *

YYYY

Previous College Education/Degree *

Hobbies, interests *

Preferred meeting format *

One-on-one in person

Small group in person (1 volunteer to 2-3 partners)

One-on-one online (Zoom, FaceTime, or other platform)

Small group online (Zoom, Facetime, or other platform)

Available times to meet with your volunteer: *

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
*

0 - No Proficiency - Know a few words but cannot form sentences or carry on a conversation

1 - Elementary Proficiency - Able to form basic sentences, including asking and answering simple questions.

2 - Limited Working Proficiency - Able to carry on limited casual conversations at the office and discuss your personal life.

3 - Professional Working Proficiency - Able to speak at a normal speed in the language, make contributions to office meetings, and discuss your personal life or current events.

4 - Full Professional Proficiency - Able to have advanced discussions on a wide range of topics about personal life, current events, and technical topics such as business and finance.

EIA Objective #3: Select reasons why you choose EIA
*

Want more opportunities to practice speaking English

Learn American culture and way of life

My professor/program recommended EIA to enhance my presentation/teaching skills

Program fee is affordable

Make new friends

Be part of a community with other EIA partners

Recommended by someone (ie. Classmate/Friend, Professor, Case Worker)

Other:

Required

YWCA Statistics #1: Ethnicity *

Black or African American

Indigenous/Native American or Alaska Native

Laitna/Latino/Latinx

Middle Eastern or North African

East Asian (e.g. Chinese, Japanese, Korean)

South Asian (e.g. Indian, Pakistani, Sri Lankan)

Southeast Asian/Pacific Islander (e.g. Vietnamese, Filipino, Cambodian, Tongan)

White/Caucasian

Mixed race

Prefer not to answer

Other:

YWCA Statistics #2: Age *

Under 18

18 - 30

31 - 40

41 - 55

55 - 65

65+

YWCA Statistics #3: Gender *

Women/Female Identifying

Men/Male Identifying

Non-Binary

Not Disclosed

YWCA Statistics #4: Do you identify yourself as part of the LGBTQ+ community? *

Yes

Prefer not to answer

YWCA Statistics #5: Household Income (annual) *

0 - $46,999/year

$47,000 - $76,999

$77,000 - $105,999

$106,000 - $157,999

$158,000 +

Prefer not to answer

YWCA Statistics #6: Which community do you live in? *

Oakland

Berkeley

Alameda County [not Berk/Oak]

San Francisco County

Contra Costa County

Outside the Bay Area

Any questions?

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