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-CIE Academy Tuition Only

Choose the University Applying For (Please Circle One): 

PRC-CIE Academy    |   CIPE    |   BLCU    |   Peking University   |   Tsinghua University    |   UIBE

Other: _______________________________

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.

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 (at) prcstudy.com. For questions regarding application, please e-mail admission (at) prcstudy.com.