Application Form for Chinese Bridge Delegation

Florida Delegation – June 19-26, 2011

Personal Information
Title: / □ Mr. □ Ms. □ Mrs.
Name: / First Name:
Middle Name:
Last Name:
Position:
Passport Number:
Country/Authority that Issued Passport:
Passport Expiration Date:
Contact Information / Office / Phone Number:
Fax:
Address:
Home / Phone Number:
Address:
E-mail:
School/Institution Information
Institution Name:
City: / State:
District: / ZIP:
Address 1： / Address 2：
Institution Type: / □ Elementary School □ Middle School □ High School
□ Department of Education □ School District
Other( please specify):
Institution Sector Type: / □ Public □ Private □Religious
Other( please specify):
Q1 / Have you participated in the program before?
□ Yes. When: / □ No.
Q2 / Did you receive permission to apply?
□ Yes. / Chief Admin Name: / □ No.
Chief Admin Email:
Chief Admin Phone:
Q3 / Does your school currently offer Chinese Language and/or culture classes? (VERY IMPORTANT)
If YES, please go to Q8. If NO, please go to Q4.
If your institution does not teach Chinese
Q4 / Do you have a plan to initiate a Chinese program?
□ Yes. (Go to Q5) / □ No. (Go to Q7)
Q5 / When do you plan to start the Chinese program?
□ 2011--2012 □ 2012--2013 □ 2013--2014
Q6 / What makes you think is necessary to start a Chinese program?
Please specify:
Q7 / Which of the following do you think will be critical in the process of initiating a Chinese program
□ Teaching-Learning Materials □ Guest Chinese Teachers □ Chinese Reference Books
□ Audio-Visual and Books Introducing China and Chinese Culture
Other (please specify):
If your school/district already has a Chinese program:
Q8 / In what grades do you offer Chinese classes in your school/district?
□ K--6 □ 6--9 □9--12
Q9 / How many students currently enrolled in your Chinese classes?
Q10 / In what ways are the Chinese classes offered?
□ A formal part of the curriculum □ After school/ Interest Class
Q11 / The Chinese teachers in your school are:
□ Full-time teacher □ Part-time teacher
□ Guest teachers from Hanban-Collegeboard Program
□ Local teachers certified in teaching Chinese as a second language
□ Local teachers graduate from a degree program
Other (please specify):
Q12 / What are the special features of Chinese classes in your school?
□ Immersion Program □ Guest Teachers □ Student trips to China
□ Staff Exchanges □ Pen/E-pal program □ Online Initiatives
□ After-school Activities □ Culture-based Activities □ Partnerships with Other Institutes
Other (please specify):
Q13 / Which of the following will be helpful to enhance and expand your program?
□ Teaching-Learning materials □ Chinese reference books
□ Guest Chinese teachers □ Professional development opportunity for the teachers
□ Audio-visual and books introducing China and Chinese culture
Other (please specify):
Q14 / Do you have any existing partnerships in China?
□ Yes. Listing the name(s): / □ No.
Q15 / Do you think participating in this Chinese Bridge program will contribute to the development of Chinese program at your school/organization?
□ Yes. Please specify: / □ No.
Personal Statement
Please let us know your thoughts and reasons for wanting to attend this program
(if not enough space, attach extra pages freely.)

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