| *First Name: |
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| Middle Initial: |
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| *Last Name: |
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| Preferred Name: |
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| *Date of Birth (mm/dd/yyyy): |
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| *Gender: |
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Contact Information
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| *Preferred Email Address |
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| *Daytime Phone: |
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| Evening Phone: |
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Current Address
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| *Country: |
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| *Address Street 1: |
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| Address Street 2: |
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| *City: |
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| State (if USA): |
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| *Zip Code: |
(5 digits) |
| Passport Information |
If
you do not currently have a passport, please apply for one and provide
the passport information as soon as possible. This information is not
required with initial application.
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| Citizenship (Country): |
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| Country Passport Issued By: |
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| Passport Number: |
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| Expiration Date (mm/dd/yyyy): |
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Academic Information
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| *Academic Standing (highest level completed): |
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| *Current/Former University or College (if not applicable, enter N/A): |
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| *University Graduation Date (mm/yyyy): |
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| *Major(s): |
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| Minor(s): |
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| *Cumulative GPA: |
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| Have you previously studied the Mandarin Chinese language? |
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| Approx. how many simplified characters can you recognize?: |
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| What level Chinese do you intend to study? |
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| Program Information |
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| Program Type: |
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| *Desired Term: |
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| Preferred Dates of Immersion Program (if applicable): |
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| Housing Accomodation: |
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Emergency Contact Information
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Primary Contact
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| *Name: |
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| *Relationship: |
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| *Email Address: |
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| *Country of Residence: |
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| *Home Phone Number (include country code): |
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| Cell Phone Number: |
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| Applicant Signature |
I declare that: |
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The above information and the documents included in my application are accurate and correct to the best of my knowledge. |
| |
I
agree to abide by the laws of the People's Republic of China and agree
not to engage in any illegal activities during my academic pursuits in
China. |
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I have read and I accept The Chinese Language Institute’s Terms and Conditions. |
| Electronic Signature of Applicant: |
I agree with the declarations stated above. |
