Share Your MIUSA Story

Name (Required)

Please enter your full name in the blank field. Then hit Tab to get to the next last name field. JAWS users should keep the forms mode on throughout the entire form.

Your E-Mail Address (Required)

Organization

Fill in the name of your workplace, organization, school, etc. if applicable.

Mailing Address

To enter your information, use the Tab button to advance from the address field to the city, state, and zip code blank fields that follow.

City

State

Zip Code

Country

What was your involvement with MIUSA?

Mark all that apply by clicking in the checkbox next to each item, or by using the Tab key to move between options and pressing the Spacebar to place a check in the box.

Involvement with MIUSA (Required)

Host Family

Intern/Volunteer/Board Member

Staff/Consultant

Colleague/Individual who utilized our services, resources or trainings

Exchange Alumni (Fill in the program name and year in the field below)

Other (Specify below)

Program Name and Year or Other

If you are a former MIUSA delegate, please provide the name and year of the program in which you participated. If you marked 'Other' above, please write a brief explanation below.

What impact did MIUSA have on you personally and professionally?

Maximum 100 words

Tell us your favorite MIUSA memory or experience (funny, dramatic, life changing)

Maximum 100 words

What are you doing now (personally and/or professionally)?

Maximum 100 words

What message do you have for MIUSA on its 30th Anniversary?

Maximum 100 words

Upload an image of yourself during your MIUSA experience and/or now.

Please upload the highest quality photo (jpeg or TIFF are preferred) possible without exceeding the 2Mb limit

Our goal is to hear from all of you who are part of the MIUSA family. We will be sending you a 30th Anniversary memento, once we have received your response!

Please be patient when submitting as it can take up to one minute to process. If you do not receive a thank you page to show it has gone through, we may still receive your completed form. You can call 541-343-1284 tel/tty to verify or wait 1-3 days to see if you receive a thank you email from us.

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Share Your MIUSA Story

Thank you, Shukrun, Gracias, Merci, Toda Rabah, Xie Xie, Danke!