Mr / Mrs / 

Ms / Miss / Dr

Chinese Name:

First & Middle Name: 

Last Name: 

Age: 

Place of Birth:   

Male / Female:

Address: 

City:

State/Province: 

Zip Code:

Country:

Native Language:

Second Lauguage:

Home Tel with Country & City Code

(        ) (        )

Work Tel with Country & City Code

(         ) (        )

Fax with Country & City Code

 (        ) (        )

Mobile with Country & City Code

(        ) (        )

Email 1: 

Email 2: 

Occupation:  

Academic Institution / Company / Employer: 

PRC Study Program Service Options (Please Circle One):

Standard       |       Premium       |      Corporate Premium      |       PRC Study Academy Tuition Only

Choose the University Applying For (Please Circle One): 

PRC Study Academy    |   CIPE    |   BLCU    |   Peking University   |   Tsinghua University    |   UIBE

Program Name:

Study Duration:
(    )Weeks;
(    )Semester; or
(    )Year

Program Code: 

Program Start (i.e. Month / Day / Year):  

Program End (i.e. Month / Day / Year):

Kindly State Previous Mandarin Chinese Language Studies Below (State number of hours or years and where learnt )

Dates

Name of Institution / School

Hours Studied Per Week

Level ( or Martial Arts Styles )

Circle the most appropriate number of Chinese words you know:

None (Total Beginner)      |     Approx. 800      |      Approx. 1500      |     Approx. 2500      |      Approx. 3500     |     4500 or more

Are you receiving a credit transfer for this Program from your college or university?   Yes  |    No       If yes, how many credits?

What other languages have you studied?

How did you hear about this China language program? 

Google    |    Yahoo    |    Brochure    |    University    |    Friend    |   Family    |    Newspaper   |   Magazine    |    Agent   |   Other

Other, please specify:

Have you participated in another PRC Study Program before?    Yes   |    No 

Accommodation (Please Circle One):

Dorm | Student Flat | Apartment | 

Hotel  | Homestay

Please Circle One:

Private | Two Sharing | 

3 Sharing (Apartment Only)

Extra Nights

Accommodation: 

(     ) Extra Nights

Accommodation Start (day before start of program):  

Accommodation End (day after the last day of program):  

For Shared Accommodation & Homestay: 
   

        Do you smoke?            Yes  |  No

        Are you a vegetarian?   Yes  |  No 

Do you prefer to live in a smoke-free room?

        Yes     |      No      |      Doesn't Matter

Comments  (i.e. Joint Application - state name of joint applicant; other requests regarding accommodation or things PRC Study should know about):

Emergency Contact Person Name & Relationship 

(i.e.Mother):

Home Tel with Country & City Code

(       ) (      )

Work Tel with Country & City Code

(       ) (      )

Mobile with Country & City Code

(       ) (      )

Fax with Country & City Code

(       ) (      )

Email:

Address: 

Date Application Fee (US$100) & 

Program Deposit (US$200) was paid (M/D/Y):

Bank Transfer Amount Paid:

Name of Bank:

Program Fee:  

US$ 100  Application   +  US$_________  Program

=  US$____________   Total Fee

Enrollment Deadline (i.e. MM/DD/YY):( Note:All bank charges are paid by the applicant )  

I declare that: 

1. The above information provided and documents given in support of my Application are complete, true and correct.
2. I agree to abide by the laws of the People's Republic of China and agree not to engage in any illegal activities during my academic pursuit in China.
3. I have read and I accept PRC Study's Programs Terms and Conditions.
4. I agree to observe and accept all Rules, Regulations and Conditions of the all host schools / institutes / organizations.
5. I have read and I accept the terms and conditions for the insurance and medical membership provided by InterGlobal Limited.

___________________________________		_____________________

 Signature of Applicant  Or Parent (for Ages 17 & Under)                                                     Date

For comprehensive information on PRC Study's Study Programs, including fees and schedule and how to apply, please visit www.prcstudy.com.

For general questions, please e-mail info@prcstudy.com. For questions regarding application, please e-mail admission@prcstudy.com.

OR contact PRC Study at Suite 1907, Tower C, Cai Zhi Intelli-Center, No. 18 Zhongguancun East Road, Haidian District, Beijing, 100083, China Tel: (8610) 8260-1330 Fax: (8610) 8260-0030