file 2-application form 2017 chinese bridge tour application form for 2017 chinese bridge tour for...
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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 [email protected] / Fax: (415)405-2866 / Tel: (415) 338-7631