University of Delaware

Institute for Global Studies

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MEPI Questionnaire

Participant Questionnaire

If you prefer, you may print this form out and email it to

Given Names:
Family Names:

What do your friends call you or what name would you like us to call you?:

Email Address:

Sex or Gender:

What is your passport number?

By what country (or authority) is your passport issued?

What is your passport expiration date (month/day/year)?


What is your passport issue date (month/day/year)?

Have you ever been issued a Social Security Number or a Tax Payer Identification number by the United States Government? These numbers are in the format 123-45-6789.

What is your complete home mailing address?

What is your home telephone number?

What is your mobile telephone number?

Do you have any medical conditions which we should know about or are you on any prescription medications?

Do you have any dietary restrictions? If so, please describe? (for example, do you eat beef, consume pork, eat only meat that is halal, consume alcohol. Please note any dietary restrictions you have or special considerations that we may need to know)

What university/school/college are you currently attending?

What are your current academic interests - what do you enjoy studying?

What are your career plans?

What do you like to do for fun?

When you think about coming to America for the MEPI program, what are two or three things that you are worried about?

Are there any special ways in which we can help make you feel more comfortable during your stay?

When you think about coming to America for the MEPI program, what are two or three things that you are very excited about?

What topics are you excited to learn about in the US?

Is there anything special that you hoped to be able to do in the US?

Why do you think you were selected from among so many applicants to participate in this program?

Please list any places where you have lived or traveled outside your country:

Is there anything else that you would like us to know about you?

Has your visa been issued?


Thank you for your time in completing this questionnaire!


  • Institute for Global Studies  •  Clayton Hall, 100 David Hollowell Drive  •   Newark, DE 19716, USA
    Phone: (302) 831-2852  •   Fax: (302) 831-6042  •   © 2017