Confucius Institute at San Francisco State University
2010 汉语桥-美国高中生夏令营申请表
Application Form for 2010 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）/ Please provide information about yourself
below in English. Please print.
1. 申请人情况/Personal information：
照片
Photo
姓名/Name: _____________________________________________
First
Middle
Last / Chinese Name
出生日期/Date of birth: ____________________________________
MM / DD / YYYY
出生地点/Place of Birth: 国家/Country:_________
城市/City:______
国籍/Citizenship: _______________________
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/Chinese Lauguage Background of Family Members:__________________
_____________________________________________________________________________
电话/Tel: ______________________________ 传真/Fax: _____________________________
电子邮件 E-mail: ______________________________________________________________
2. 学校信息/School information
学校名称/School Name: ___________________________________
年级/Grade: __________
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学校地址/School Address: (including zip code)
_______________________________________________________________________________
_______________________________________________________________________________
3. 紧急联络人信息
联络人 1/Contact #1
姓名/Name: ________________________ 家庭电话/Home Phone: _____________________
办公电话/Office Phone: ___________________ 手机/Cell Phone: _______________________
联络人 2/Contact #2
姓名/Name: ________________________ 家庭电话/Home Phone: _____________________
办公电话/Office Phone: ___________________ 手机/Cell Phone: _______________________
4. 汉语水平/Chinese Language Proficiency:
是否学过中文？/Have you learned Chinese already?
是/Yes
否/No
如果是，学习中文多长时间？/ If "YES", how long have you been learning Chinese?
______________________________________________________________________________
中文水平/Chinese Language Proficiency (Basic, Intermediate, Advance):
______________________________________________________________________________
是否去过中国?/Have you been to China before?
是/Yes
否/No
如果是，上次在中国住了多长时间?/If "YES", how long did you stay in China last time?
______________________________________________________________________________
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?
2
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 state the reasons why
you would like to participate in the Summer Camp (Please attach a separate sheet, maximum 250
words).
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 for your
application by one teacher from your school. List the referee 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:/ I hereby certify that:
本表所填写的内容和提供的材料真实无误/ All the information on this form is true and correct.
申请人签字/Signature of Applicant:___________________________________
日期/Date：____________
*Applicants should fill out and turn in this Application Form with all required materials to Confucius Institute at
San Francisco State University before the deadline May 3, 2010:
Confucius Institute at SF State
Tel: 415-338-7631
1600 Holloway Ave. Burk Hall 325
` Fax: 415-405-2866
San Francisco, CA 94132
Email: cisfsu@sfsu.edu
Attention: Ms. Yaqi Liu
Application forms can be downloaded at http:// www.sfsu.edu/~ci/
Personal Application Statement
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Please write a short essay explaining what you expect to learn in China and why it is important.
(Use the space provided and additional paper if necessary. (250 words maximum)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Signature: ______________________
Date: __________________________
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Check List for Summer Camp Students
Applicants for the Summer Camp should turn in the following before May 3, 2010:
(1)
(2)
(3)
(4)
(5)
Application Form
A non-refundable application fee of $150 (payable to: CI at SF State).
A recommendation letter from the student’s teacher or princpal;
A personal statement: Why you want to participate in the Summer Camp (250 words);
Three recent passport photos (application form, visa, CI records);
To apply for your visa, you need to turn in the following items before June 1, 2010:
(1) A completed Chinese Visa Application Form
(2) Passport
(3) Visa application and handling fee: $150
* $130 Cashier's Check payable to :Chinese Consulate
* $20 Personal Check payable to : CI at SF State
Please MAIL or DELIVER IN PERSON all application materials in one envelope to the following
address:
Confucius Institute at SF State
San Francisco State University
1600 Holloway Ave., Burk Hall 325
San Francisco, CA 94132
Attn: 2010 Summer Camp for US High School Students
Thank you for your interest in our programs. Please email Yaqi Liu: cisfsu@sfsu.edu with
questions or for more information. We look forward to reviewing your application!
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