孔子学院总部/汉办
Confucius Institute Headquarters (Hanban)

汉语考试夏令营申请表
Application Form for Mandarin-Test Summer Camp

请用中（英）文填写此表格并打印。Please complete the following form in Chinese or English and print.
1.基本信息 Basic Information
姓名 Name (as shown in passport)	

照片
Photo	
性别Gender      □男Male      □女Female		
国籍Nationality		
出生年月Date of Birth(dd/ mm/ yyyy)                  		
护照号码Passport Number	护照有效期Passport Expiration Date	
紧急联系人电话 Emergency Contact Number	电子邮件E-mail	
通讯地址（含邮编）Current Address（including zip code）		
学校名称School Name	年级Grade	
学校地址School Address（including zip code）	
2.语言能力Language Proficiency
学习中文多久？How long have you been learning Mandarin？	
中文水平Mandarin Proficiency
基础Basic□   初级Elementary□   中级Intermediate□   高级Advanced□	
是否来过中国？Have you been to China before?      是Yes□     否 No□	
如果是，曾去过中国哪些地方？有何印象？If yes, where have you ever been to China? What’s your impression about China?	
3. 谈谈你对夏令营的期待。(不超过150字)  
Please talk about your expectations to Summer Camp. (within 150 words)
	
4. 推荐人信息(请另附推荐信) Information of Referees (Please E-mail the recommendation letter separately)
姓名Name	机构Institution	职称Title	
联系方式E-mail or Telephone	
Acknowledgement
I ,______________understand that: 
While visiting a foreign country or countries, the student will be expected to maintain a standard of behavior and integrity that will reflect positively on Confucius Institute Headquarters (Hanban), China, which is the sponsoring organization (hereafter referred as Hanban), the student’s university, family and the student.

The student and parent and guardian further understand and acknowledge that the student has a responsibility to obey the laws of the country being visited and to behave in a mature and appropriate manner.  The student and family agree to conform to these standards and understand that if the student fails to do so the student shall be subject to discipline up to and including being sent home with no refund as well as criminal penalties if applicable.

The student, parents and guardian agree that the student shall not engage in any illegal activity, nor will the student engage in activities not in compliance with the academic spirit of this trip or that are detrimental to the learning experience of others.

I understand that Hanban, the sponsoring institution of this event and its officers, administrators, and other employees are not responsible for any of the following:
1. The safety of participants or eliminating risk from the off-campus study environments.
2. Monitoring or controlling all the daily personal decisions, choices, and activities of individual participants.
3. Preventing participants from engaging in illegal, dangerous, or unwise activities.
4. Assuming responsibility for the actions of persons not employed or otherwise engaged by the program sponsor for events beyond the control of the sponsor and its subcontractors, or for situations which arise due to failure of a participant to disclose pertinent information. If the Student, parent or guardian is unable to attend the pre-departure orientation sponsored by the lead faculty member, I will make arrangements to obtain and absorb the information contained therein before departure.

申请人保证： I Hereby Affirm That:
●本表所填写的内容和提供的材料真实无误。All information and materials given in this form are true and correct.
●我已阅读《免责协议》并保证遵守。I have read the Acknowledgement and shall abide by it.
申请人签字Signature of the Applicant ______________________      
未成年学生家长签字Parent of the minor’s Signature______________
日期Date__________________