Student Application Form

USF STARTALK

Summer Chinese Intensive Language Learning Academy

for High School Students

August 5–19 (9:00am-4:00pm), 2011

University of South Florida

Department of World Languages Confucius Institute

1. Personal Information

Name:______Chinese Name (if you have one): ______

Date of Birth (D)/ (M)/ ___(Y)

Place of Birth (City, State, Country) ______

Sex: Male ___ Female ___

Home Address: ______

City: ______Zip Code ______County ______

Telephone (home): Cell Phone: ______
E-mail address (Please print clearly): ______

Your current grade level at school (current 9th-12th graders eligible): ______

Name and address of your school: ______

2. Language Background

This summer Chinese academy is designed for students whose first language is not Chinese. List any foreign language courses you have taken, including Chinese courses:

Course Title / School / Dates Taken / Credits Received

What do you consider to be your native language?
What language is spoken most frequently in your home?

Have you ever lived or studied in a country other than the U.S.? Yes ___ No ___

If yes, where and for how long?

3.Please rate your level of proficiency in Mandarin Chinese.

Evaluate your own ability in Chinese according to the scale below. (Circle your response.)

2 (High) 1 (Low) 0 (Zero) X (unknown)

Ability to engage in daily conversation 2 10 X
Ability to communicate in a variety of situations 2 10 X

Ability to read newspapers and magazines 2 10 X
Ability to write effectively 2 10 X

4. Reference

If you are currently not enrolled in a Chinese language class, please ask any teacher of yours to provide a reference letter. If you are currently enrolled in a Chinese language program, please ask your teacher of Chinese to provide a reference for you.

5. Statement of Understanding

The USF Summer Chinese Intensive Language Learning Academyprovides intensive Chinese language and culture instructionduring the period of August 5-19, 2011 on the USF Tampa campus (inside the College of Education building). Except for a $100 registration fee (covering USF college credit registration fee of $30/person, camp T-shirt and partial learning material), there is no additional cost to the selected students at the two-week academy, including food and soft drinks. I understand that the course of study requires a full-time commitment during the above program period, including daily lessons, activities, and homework. I understand that I (student) should not take other classes or have jobs during the above program period without prior written permission. I fully understand the nature of this intensive program and will abide by its requirements and guidelines. I also understand that submitting this application does not guarantee my enrollment into the program.

Student name (print) ______(signature)______Date ______

Parent/ guardian (print) ______(signature) ______Date ______

Please submit the completed application form and a check of $100 (payable to the University of South Florida) for registration to the address below. If you are not accepted into the program, your registration check will be returned. The deadline to submit application is May 13 (Friday), 2011.

University of South Florida

Confucius Institute

4202 East Fowler Avenue, CGS101

Tampa, FL 33620

For questions, please .