2017 Discovering China Program
Confucius Institute | Texas A&M
Personal Information
First Name (as it appears on passport or birth certificate)
Your answer
Middle Name (as it appears on passport or birth certificate)
Your answer
Family Name (as it appears on passport or birth certificate)
Your answer
Date of birth
MM
/
DD
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YYYY
Gender
Passport Number (if available)
Your answer
Passport expiration (if available)
MM
/
DD
/
YYYY
Nationality (as it appears on passport or birth certificate)
Your answer
Email Address (student's)
Your answer
Grade (for 2017/2018 school year)
School Name and District
Your answer
Background and Interest
Do you have any Chinese language (Mandarin) ability? Please describe your level, if any, and how you learned it. (Note: Chinese language ability is not required)
Your answer
Have you been to China before? If so, when and where.
Your answer
List any activities you have been involved in at your school (student government, sports, arts, music, etc.).
Your answer
List any public or community service activities you have been involved in.
Your answer
List any jobs or internships you have had.
Your answer
List any awards, scholarships, or special recognitions you have received.
Your answer
Please write a one paragraph statement stating why you are interested in participating in this program.
Your answer
Emergency Contacts
Contact #1 Name (Parent/Guardian)
Your answer
Contact #1 Phone Number (Parent/Guardian)
Your answer
Contact #1 Email Address (Parent/Guardian)
Your answer
Contact #2 Name (Parent/Guardian)
Your answer
Contact #2 Phone Number (Parent/Guardian)
Your answer
Contact #2 Email Address (Parent/Guardian)
Your answer
*Daily update contact
We will attempt to send a daily email update to the email of parents or guardians that you provide below:
Contact email:
Your answer
Additional requirements to be completed by November 28th:
1. $50 deposit (this will go towards expenses paid for by the Confucius Institute on behalf of
all students) Confucius Institute, 3371 TAMU, College Station, TX 77843
2. Letter of recommendation from teacher or other responsible adult (not a parent) to be
emailed to Amanda Johnson at azj@tamu.edu
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