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2017中国“寻根之旅”夏令营(福建营)报名表
2017“Seeking Roots” Summer Camp for Chinese American Youths(Fujian) - Application Form
营员资格要求 Camper Requirements
长年生活在美国的华裔青少年,年龄在12-18周岁之间
有一定的中文表达和沟通基础,身体健康,有独立生活能力

Campers need to be Chinese American youths and aged between 12- 18 years old who live in America all year round.
Campers should have basic Chinese listening and speaking skills, and abilities to live independently.

我们会在收到报名信息后进行审核和选拔,在报名结束后通知您结果。
We will notify you the results as soon as we done the information collecting.

如有疑问,请联系亚洲文化中心,(212) 679-8833或者summercamp@acngusa.com
If you have any questions, please contact us at (212) 679-8833 or summercamp@acngusa.com

学生信息 STUDENT INFORMATION
以下所有资料皆需完整无误填写,所有资料仅供本次活动使用,主办单位不会将资料外泄或做其他用途;活动结束后,相关资料将有主办方自动销毁。
中文姓名 Chinese Name:
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英文姓名 English Name
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性别 Gender
出生日期 Date of Birth
MM
/
DD
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YYYY
国籍 Nationality
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护照号
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家庭地址 Address
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电邮 E-mail
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身高 Height
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体重 Weight
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衣服尺码 Clothes Size
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特长爱好
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中文能力
宗教信仰 Religion
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饮食禁忌 Dietary Restriction
重大病史 Major Medical History
过敏药物及食品 Allergies
就读学校 Current School
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获奖信息 Honors received
请详细注明获奖时间,获奖名称(注明州/省/市级),以及获奖等级。 Please share with us in detail about your awards(date, name, rank), strengths or any kind of achievements.
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监护人信息 PARENT/GUARDIAN INFORMATION
姓名 Name
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手机 Phone
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电邮 E-mail
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