| *First Name: |
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| Middle Initial: |
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| *Last 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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| *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) |
| 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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Approx. how many simplified characters can you recognize?: |
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*Rate your current Chinese level (0 is absolute beginner, 5 is highly advanced): |
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| Program Information |
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| *Program Type: |
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| *Desired Term: |
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*Program Start Date: |
(All coursework begins on Mondays) |
| *Housing Accomodation: |
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| *CLI Meal Plan: |
(Home-cooked lunch at CLI M-F, $15 per week, amount will be added to program fees) |
| *CLI Pengyou Program: |
(Please reference the Pengyou Program section for more info) |
| How did you hear about CLI?(optional): |
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Emergency Contact Information
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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 included in my application is accurate and correct to the best of my knowledge. |
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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 all declarations stated above. |
