file 2-application form 2017 chinese bridge tour application form for 2017 chinese bridge tour for...

1

ApplicationFormfor2017ChineseBridgeTourforAmericanEducators

PersonalInformation

Title: □ Mr.□ Ms.□ Mrs.

Name:

FirstName:

MiddleName:

LastName:

Position:

PassportNumber:

Country/AuthoritythatIssuedPassport:

DateofIssue:PassportExpirationDate:

ContactInformation

Office

PhoneNumber:

Fax:

Address1:

Address2:

Home

PhoneNumber:

CellPhoneNumber:

Address1:

Address2:

EmergencyContact1 Name: Phone:

EmergencyContact2 Name: Phone:

InstitutionInformation

InstitutionName:

SchoolDistrict:

Address1： Address2：

City: StateandZIP:

InstitutionType:

□ ElementarySchool□ MiddleSchool□ HighSchool

□ DepartmentofEducation□ SchoolDistrict

Other(pleasespecify):

InstitutionSectorType: □ Public□ Private□ ReligiousOther(pleasespecify):

2

Q1Haveyouparticipatedintheprogrambefore?

□ Yes.When □ No.

Q2

Didyoureceivepermissiontoapply?

□ Yes.

ChiefAdminName:

□ No.ChiefAdminEmail:

ChiefAdminPhone:

Q3Doesyourschool/SchoolDistrictcurrentlyofferChineseLanguageand/orcultureclasses?

IfYES,pleasegotoQ8.IfNO,pleasegotoQ4.

IfyourinstitutiondoesnotofferChineselanguageandculturecourses

Q4DoyouhaveaplantoinitiateaChineseprogram?

□ Yes.(GotoQ5) □ No.(GotoQ7)

Q5WhendoyouplantostarttheChineseprogram?

□ 2017--2018□ 2018--2019□ 2019--2020

Q6WhatmakesyouthinkisnecessarytostartaChineseprogram?

Pleasespecify:

Q7

WhichofthefollowingdoyouthinkwillbecriticalintheprocessofinitiatingaChineseprogram

□ Teaching-LearningMaterials□ GuestChineseTeachers□ ChineseReferenceBooks

□ Audio-VisualandBooksIntroducingChinaandChineseCulture

Other(pleasespecify):

Ifyourschool/districtalreadyhasaChineseprogram:

Q8InwhatgradesdoyouofferChineseclassesinyourschool/district?

□ K--6□ 6--9□ 9--12

Q9 HowmanystudentscurrentlyenrolledinyourChineseclasses?

Q10

InwhatwaysaretheChineseclassesoffered?

□ Aformalpartofthecurriculum□ Afterschool/InterestClass

3

Q11

TheChineseteachersinyourschoolare:

□ Full-timeteacher□ Part-timeteacher

□ GuestteachersfromHanban-CollegeboardProgram

□ LocalteacherscertifiedinteachingChineseasasecondlanguage

□ Localteachersgraduatefromadegreeprogram

Other(pleasespecify):

Q12

WhatarethespecialfeaturesofChineseclassesinyourschool?

□ ImmersionProgram□ GuestTeachers□ StudenttripstoChina

□ StaffExchanges□ Pen/E-palprogram□ OnlineInitiatives

□ After-schoolActivities□ Culture-basedActivities□ PartnershipswithOtherInstitutes

Other(pleasespecify):

Q13

Whichofthefollowingwillbehelpfultoenhanceandexpandyourprogram?

□ Teaching-Learningmaterials□ Chinesereferencebooks

□ GuestChineseteachers□ Professionaldevelopmentopportunityfortheteachers

□ Audio-visualandbooksintroducingChinaandChineseculture

Other(pleasespecify):

Q14

DoyouhaveanyexistingpartnershipsinChina?

□ Yes.Listingthename(s)andcontactinformation:

□ No.

Q15

Medical&AllergyInformation:

Q16

DietaryRequirements:

4

PersonalStatementPleaseletusknowyourthoughtsandreasonsforwantingtoattendthisprogram

MAIL or SCAN-EMAIL or FAX your Application Form before March 24, 2017 to: Confucius Institute at SF State 1600 Holloway Ave., Burk Hall 325 San Francisco, CA 94132 Email to plj2016@sfsu.edu / Fax: (415)405-2866 / Tel: (415) 338-7631