startalk Alumni application 2011 by k7ww9kn

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									                                      Please type, or print clearly.
           The STARTALK Seminar Application for StarTalk Alumni
        College of Education, University at the University of Florida, July 11-29, 2011

 The application for StarTalk alumni consists only of this application form. See page 2 for fees.

Please mail applications to: StarTalk seminar, School of Teaching and Learning, College of Education,
University of Florida, PO Box 117048, Gainesville, FL 32611. Application review will begin as received
and continue until all spaces are filled. We hope to fill all spaces by May 1. You will be asked to sign a
contract of participation when you are accepted.

Name:

Chinese Name:

Gender: ___ Male ___ Female      Date of Birth _______________ Nationality_______________________________

Home address:



Home phone number:

Cell Phone (only for emergency and immediate contact):

Email address (that you will receive over the summer months):

Native or Non-native speaker of Mandarin Chinese ____ Native ____Non-native _____

School Name:

School Address:



School Phone number:

Teaching position:

Please list your educational degrees beginning from the most recent one. Please include degree major,
institution and years of attendance.




( Y / N ) Do you hold a teacher certificate? If yes, in what subject area? When did you obtain it?




( Y / N ) Are you a practicing teacher of Chinese, grades 6-12?
                                           Please type, or print clearly.


          If so, what grade(s) do you teach? __________


          List the main textbook(s) that you use: _______________________________________________________________

______________________________________________________________________________________________________________________

(Y / N ) If you are not a practicing teacher of Chinese, are you seeking employment as one by 2013? If
“no,” please state your timeline and future plan about the teacher certificate.




Current status and where you have taught




Please tell us when and where you have attended what professional workshops, seminars, summer
institutes, etc.



If you have a laptop, please bring it. If you don’t have one or cannot borrow one and are interested in
laptop rental ($129 for two weeks) from a non-UF business, please check here____.



□ I understand that there is a $450 nonfundable registration fee for this seminar as my share of the
$1400 tuition for the program, which must be remitted at the same time as my signed contract. I
understand that if I need a parking for my car, I will need $2.00 per day to pay for a parking tag. I
understand the parking tag fee must be remitted no later than June 14.

Signature: _________________________________________________

How did you find out about this seminar?




You must meet UF requirements for immunization against German measles and rubella in order
to attend this seminar.

								
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