第二篇：汉语桥-美国高中生夏令营学生申请表
汉语桥-美国高中生夏令营学生申请表
Application Form for Chinese Bridge Summer Camp
for American High School Students
请用英文回答下面的问题（电脑打印或用正楷填写）1. 申请人情况/Personal information 姓名/Name: __________________________________
出生日期/Date of birth: ____________________________________
国籍/Nationality: _______________________
性别/Gender: 男/Male 女/Female
护照号码/Passport #: __________________________________
护照有效期/Passport Expiration Date: ________________________________
第一语言/First Language:____________________________________________________ 第二语言/Second Language:___________________________________________________ 家庭成员华文背景/Does your family have any Chinese Background:______________________ ____________________________________________________________________________
2. 学校信息/School information
学校名称/School Name: ___________________________________ 年级/Current Grade: ____ 学校地址/School Address: (please include zip code)
_______________________________________________________________________________
3. 紧急联络人信息/Emergency Contact Information
联络人1/Contact #1
姓名/Name: ________________________ 家庭电话/Home Phone: _____________________ 办公电话/Work Phone: ___________________ 手机/Cell Phone: _____________________ 联络人2/Contact #2
姓名/Name: ________________________ 家庭电话/Home Phone: _____________________ 办公电话/Work Phone: ___________________ 手机/Cell Phone: _____________________
4. 汉语水平/Chinese Language Proficiency:
是否学过中文？/Have you studied Chinese previously? 是/Yes
如果是，学习中文多长时间？/ If yes, for how long?
__________________________________________________________________
中文水平/Chinese Language Proficiency (Basic, Intermediate, Advance):
__________________________________________________________________
是否来过中国?/Have you been to China previously? 是/Yes 否/No 否/No
如果是，上次在中国多长时间?/If yes, for how long did you stay?
__________________________________________________________________
5. 医疗信息/Medical Information
1) 你目前是否在接受治疗？/Are you currently receiving medical treatment?
是/Yes 否/No
如果是，请解释/If yes, please explain__________________________________
__________________________________________________________________
2)你目前是否在接受心理咨询或治疗？/Are you currently receiving counseling or medication for any psychological or emotional conditions?
是/Yes 否/No
如果是，请解释/If yes, please explain__________________________________
__________________________________________________________________
3)你是否有任何过敏？/Do you have any allergies?
是/Yes 否/No
如果是，请解释/If yes, please explain__________________________________
__________________________________________________________________
6. 请陈述申请参加夏令营的原因。（请附详细说明，最多250字）/Please explain the reasons why you would like to participate in the Chinese Bridge Summer Camp Program. (Please attach as a separate sheet, 250 words maximum).
7. 请附上贵校教师推荐信一封并提供推荐人信息/Please attach a letter of reference written by one teacher from your school. Also, please list his/her information below.
姓名/Name 联系电话或邮箱/Phone# or Email 职务/Title
_______________ _________________________ __________________
8. 申请人声明/Declaration of applicant:
我特此证明本表所填写的内容和提供的材料真实无误。
I hereby certify that all of the information provided in this application is true and accurate.
