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联合教育申请注册表

作者:线上ag赌场注册|注册 出处:原创 人气:2866
EDUCATION CONNECTION REGISTRATION FORM
联合教育申请注册表
Attach a recent photograph Birthdate (Month/Date/Year) Sex: ___M ___F
照片 出生日期(月/日/年) 性别:___男___女
Applicant’s Name
申请人姓名
Chinese: Pinyin:
中文:_____________________拼音:___________________
English (if applicable):
英文姓名(如果有):_________________________________
Mailing Address: (pinyin)
邮寄地址(拼音):___________________________________________________
Home Telephone: Current Grade:
家庭电话:__________________________目前就读年级:_________________________
Student’s Mobile (Cell) Phone: Email:
学生手机号码:______________________电子邮件地址:___________________________
Name of School:
现所在学校名称:______________________________________________________
High School Principal’s name:
高中校长姓名(拼音):_______________________________________________
EMERGENCY CONTACT
紧急联系人
NAME: RELATIONSHIP:
姓名(拼音):________________________与申请人关系:_____________________
PHONE: EMAIL:
电话______________________电子邮件地址____________________________________
Self-Evaluation of English Language Skills: (Check appropriate box for each language skill.)
英文水平自我评估(在相关空格内打勾)
起步

段:
较低
水平
Low
Begin.
起步
阶段:
中等
水平
Middle
Begin.
起步

段:
较高
水平
High
Begin.
中级阶
段:较低
水平
Low
Intermed.
中级阶
段:中等
水平
Middle
Intermed.
中级阶
段:较高
水平
High
Intermed.
高级阶
段:较
低水平
Low
Advanc.
高级阶
段:中
等水平
Mid.
Advanc.
高级阶
段:较
高水平
High
Advanc.
阅读
Reading
写作
Writing
口语
Speaking
听力
Listening
Have you ever taken the TOEFL (Test of English a Foreign Language) or IELTS?
你曾经参加过托福考试或其它英语考试(比如IELTS)吗?是_____否______
If yes, when?________________ Score?_____________
如果是,什么时候?___________________ 分数______________
What foods are you allergic to?_______________________________________________________
你对什么食物过敏?_________________________________________________
Are you allergic to cats? Yes_____ No _____ Are you allergic to dogs? Yes_____ No_____
你对猫过敏吗?是__________否__________你对狗过敏吗?是______否______
List your interests and hobbies and activities, sports, music, etc:
请列出你的兴趣、爱好、喜欢的体育项目、音乐,及乐于参加的活动。
Tell what experience you have had with people of another culture:
你有过和其他文化背景的人交往的经历吗?如果有,请陈述。
Tell who in your family has traveled to other countries and tell where they traveled:
你的家庭成员去过其它国家旅行吗?如果有,请说明是哪位家庭成员及去过的国家。
Tell the ages and names of your brothers and/or sisters:
请写出你兄弟姐妹的姓名与年龄。
Sister(s): Brother(s):
姐妹 兄弟
Tell what difficulties you might have in the US and how you would overcome them:
请陈述你所能想到的在美国可能遇到的困难及你将如何克服它们。
PARENT OR GUARDIAN INFORMATION :
父母或监护人信息
MOTHER’S /Guardian’s Name
母亲/监护人的姓名
Chinese__________________________________________________
中文:______________________________________________
Pinyin__________________________________________________
拼音:_____________________________________________
Address: Chinese_______________________________________________
地址:中文______________________________________________
Pinyin______________________________________________________
拼音__________________________________________________________
E-Mail address________________________ Home Phone:_______________________
电子邮件地址_____________________ 家庭电话_____________________________
Cell (mobile) Phone:____________________________________
手机号码________________________________________________________
Home Address (if different from Youth Applicant):
家庭地址(如果和申请人的家庭地址不同)
_____________________________________________________________________
Occupation and Work Phone Number:
工作电话_____________________ 职业___________________________________
Tell why you want your child to participate in this CECE Global Program: (Student Translate
this into English)
请陈述为什么您希望您的孩子参加CECE GLOBAL的联合教育项目(请申请人将这段陈述
翻译成英文)
FATHER’S /Guardian’s Name
父亲/监护人的姓名
Chinese__________________________________________________
中文________________________________________________
Pinyin__________________________________________________
拼音_______________________________________________
Address: Chinese_______________________________________________
地址:中文___________________________________________________________
Pinyin:________________________________________________________
拼音_____________________________________________________
E-Mail address________________________ Home Phone:_______________________
电子邮件地址_____________________ 家庭电话________________________
Cell (mobile) Phone:____________________________________
手机号码_________________________________________
Home Address (if different from MOTHER):
家庭地址(如果和申请人的家庭地址不同)
_____________________________________________________________________
Occupation and Work Phone Number:
工作电话_____________________ 职业___________________________________
Tell why you want your child to participate in this CECE Global Program: (Student Translate
this into English)
请陈述为什么您希望您的孩子参加CECE GLOBAL的联合教育项目(请申请人将这段陈述
翻译成英文)
MEDICAL INFORMATION:
健康、医疗信息
1. List any prescribed medications that you will be taking in the US and why:
1. 请列出你在美国可能会服用的处方药及服用的原因。
2. Please list allergies, health or dietary restrictions and how these affect your daily life.
2.请详述你对食物、动物、花草等的过敏情况,在健康状况或者饮食方面的禁忌,以
及它们对你日常生活的影响。
For All Participants :
联合教育项目参加者:
I, ________________________________________PINYIN
______________CHINESE(name of participant ) agree to the following:
I will refrain from the use of drugs, tobacco, alcohol, sexual involvement, or
behaviors that will injure myself or others. I will not drive a car or motor vehicle in
the US. I understand that I must work hard at school and obey all school rules. I
understand that I am expected to participate in all activities of this CECE Global
Program. I promise to represent the values of my home, community and country
with friendship and an open heart to meeting new people and having new experiences.
I understand that if I break my agreement, I may be removed from the program at my
parent’s expense. I will not make any attempt to deviate from the requirements of my
visa. . I agree to follow all the rules and regulations of CECE Global and work hard
to adapt to life in the US.
我, (拼音) (中文名)同意以下事项:
在美国期间,我将不使用毒品,不抽烟,不饮酒,不发生性行为,不驾驶汽车或摩托车,
不做出伤害到自己或他人的行为。 我明白我在学校要努力学习,并遵守所有的校纪校
规。我明白我必须参与CECE GLOBAL联合教育项目的所有活动。我保证以友好、开放的
心态结交新朋友、体验新经历,已体现我所来自的家庭、社区和国家的价值。我知道,
如果我违反了协议,我将不能继续参加联合教育项目的任何活动,我的父母并将承担由
此产生的各种责任和费用。我将不会试图违反我的学生签证对我的要求。我同意遵守
CECE GLOBAL的所有规则和条例,并努力融入、适应在美国的生活。
We,__________________________________PINYIN________________CHINESE
(parents of participant) agree to release and hold harmless any officers, volunteers or
contractees of CECE Global in the implementation of this CECE Global
Program.
我们, (拼音) (中文名)(申请人的家长)同
意免除CECE Global 所有工作人员、志愿者、及合作者在举办联合教育项目中的一切法
律责任 。
Signature of PARENTS:
申请人签名:
????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
中文: 拼音 日期:
Signature of Father/Guardian: Chinese: _______________ Pinyin:____________________Date:_____
父亲/监护人签名:中文: 拼音: 日期:
Signature of Mother/Guardian: Chinese: ______________ Pinyin:____________________Date:_____
母亲/监护人签名:中文: 拼音: 日
期:
Signature of PARTICIPANT:
Chinese:___________Pinyin:___________Date:__________
参与者签名:中文: 拼音: 日期:
If you have any questions, please list them here. ??????????????问??请????详
????
COMPLETE REGISTRATION PACKET INCLUDES: ??????????????????????:
_____Registration Form ??????
______Two letters of reference in English from teachers ??份????????????????
______Copy of Passport Identification Page ??????????
______Three Paragraph Essay ( My family life, My school life, My
thoughts about a year in the US)
??????????(????????????,????????????,??????????????????)
______Health Form ??????????
______Temporary Guardianship Form ????????????????
______Permission to Travel Outside State Form ????????????????????
______Digital Photograph ??????????????
______Statement of Credit Worthiness/ Bank Statement to prove parents have enough money/assets
to cover expenses while in the US.
????????????够????????产????????????????????????????产????
______Birth Certificate ????????
______School Transcript of Courses and Grades ??????????

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