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2024 CCYLA Application Form
Submit This Form Before June 30th, 2024
Award Information:
caagc.org
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* Indicates required question
Student Information
English Name:
*
Your answer
Chinese Name:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Gender:
*
Male
Female
High School:
*
Your answer
Father Information
English Name:
*
Your answer
Chinese Name:
*
Your answer
Phone:
*
Your answer
Email:
*
Your answer
Mother Information
English Name:
*
Your answer
Chinese Name:
*
Your answer
Phone:
*
Your answer
Email:
*
Your answer
Reference 1 Information
Name:
*
Your answer
Title/Organization:
*
Your answer
Phone:
*
Your answer
Email:
*
Your answer
Reference 2 Information
Name:
*
Your answer
Title/Organization:
*
Your answer
Phone:
*
Your answer
Email:
*
Your answer
Nominating Chinese School or Organization
Chinese School and Organization List
School/Organization:
*
Your answer
Leader Info:
*
Your answer
I understand that any information submitted by me will be shared with members of the corresponding nominating Chinese school/organization and the selection committee.
*
I Agree
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