Please type, or print clearly.
The STARTALK Application for Alumni
College of Education, University of Florida 2014
http://education.ufl.edu/startalk/
Online, Wednesday, June 4th—Friday, June 13th
On Campus, Sunday, June 15th—Saturday, June 21st
Check-in and orientation, Sunday, June 15th, 4—6pm
Class, Monday, June 16th—Saturday, June 21st
Graduation, Saturday, June 21st 12-2:00pm
The application for STARTALK alumni consists only of this application form.
Please email applications to: patrjac@ufl.edu or mail applications to: STARTALK, School of Teaching
and Learning, College of Education, University of Florida, PO Box 117048, Gainesville, FL 32611.
Applications will be reviewed as they are received and continue until all spaces are filled.
You will be asked to sign a contract of participation when you are accepted.
Name:
Chinese Name:
Gender: ___ Male ___ Female
Date of Birth _______________ Nationality_______________________________
Home address:
Home phone number:
Cell phone:
Email address:
Native or Non-native speaker of Mandarin Chinese ____ Native ____Non-native
School name:
School address:
School phone number:
Teaching position:
Please list your educational degrees beginning from the most recent one. Please include degree major,
institution and years of attendance.
Please type, or print clearly.
( Y / N ) Do you hold a teaching certificate? If yes, in what subject area? When did you obtain it?
( Y / N ) Are you a practicing teacher of Chinese, grades K-16?
If so, what grade(s) do you teach? __________
List the main textbook(s) that you use: _______________________________________________________________
______________________________________________________________________________________________________________________
(Y / N ) If you are not a practicing teacher of Chinese, are you seeking employment as one by 2014? If
“no,” please state your timeline and future plans for obtaining a teaching certificate.
Current status and where you have taught:
Please tell us when and where you have attended professional workshops, seminars, summer
institutes, etc.
Please bring your laptop computer. It is crucial for completing assignments.
Signature: _________________________________________________
How did you find out about this seminar?
UF students must pay full tuition and fees.
You must meet UF requirements for immunization in order to attend this seminar
(http://shcc.ufl.edu/services/primary-care/immunizations/). Please contact patrjac@ufl.edu if
you do not have your immunization record in order to avoid registration problems.