Confucius Institute Children Registration Form
UCA Campus Classes, Conway Spring 2012
Today’s Date:____________________
Student: First Name ______________________________
Parent: First Name ______________________________
Last Name______________________________
Last Name______________________________
Street Address or Box # ______________________________________City & State_______________
Phone (home) _______________________ (work) _____________
Zip Code__________
___ Cell ______________________
E-mail address _________________________________________________
All classes will be offered at UCA TWO HOURS a week for 5 weeks (March 5-April 14).No class during Spring Break (March 19-23).
Please check which language course you are interested in taking: (See details on the UCA CI Website.)
___Mondays & Wednesdays (5:00-6:00pm)
___ Tuesdays & Thursdays (3:30-4:30pm)
___ Saturday (10:00-12:00pm)
** If your business or organization is interested in arranging group lessons, please contact the UCA CI director, Dr. Guo-ou Zhuang
gzhuang@uca.edu Tel: (501) 852-5219
Tuition is $120.00 per student (includes $20 non-refundable registration fee)
NOTE: EARLY BIRD TUITION DISCOUNT ($100 total per student) ENDS ON February 29th
Return registration form(s) with check made payable to:
UCA Foundation-Confucius Institute
201 Donaghey Ave, Conway, AR 72035
$_____________Total enclosed