2011-USF-StarTalk-Student-App

							                              Student Application Form
                                   USF STARTALK
                Summer Chinese Intensive Language Learning Academy
                               for High School Students
                         August 5 – 19 (9:00am-4:00pm), 2011
                              University of South Florida
                  Department of World Languages & Confucius Institute

1. Personal Information
Name: ___________________________________        Chinese Name (if you have one): _______________
Date of Birth           (D)/         (M)/        __ _ (Y)
Place of Birth (City, State, Country) _____________________________________________________________________
Sex:      Male ___               Female ___
Home Address: _________________________________________________________________
City: _____________________            Zip Code _____________            County ___________________
Telephone (home):                                        Cell Phone: ___________________________
E-mail address (Please print clearly): _______________________________________________
Your current grade level at school (current 9th-12th graders eligible): ______________________
Name and address of your school: __________________________________________________


2. Language Background
This summer Chinese academy is designed for students whose first language is not Chinese. List
any foreign language courses you have taken, including Chinese courses:
       Course Title                     School                       Dates Taken           Credits Received




What do you consider to be your native language?
What language is spoken most frequently in your home?
Have you ever lived or studied in a country other than the U.S.?                 Yes ___      No ___
    If yes, where and for how long?
3. Please rate your level of proficiency in Mandarin Chinese.
Evaluate your own ability in Chinese according to the scale below. (Circle your response.)
                                                     2 (High)      1 (Low)         0 (Zero)    X (unknown)
Ability to engage in daily conversation                2             1                0             X
Ability to communicate in a variety of situations      2             1                0             X
Ability to read newspapers and magazines               2             1                0             X
Ability to write effectively                           2             1                0             X


4. Reference
If you are currently not enrolled in a Chinese language class, please ask any teacher of yours to provide a
reference letter. If you are currently enrolled in a Chinese language program, please ask your teacher of
Chinese to provide a reference for you.

5. Statement of Understanding
The USF Summer Chinese Intensive Language Learning Academy provides intensive Chinese language
and culture instruction during the period of August 5-19, 2011 on the USF Tampa campus (inside the
College of Education building). Except for a $100 registration fee (covering USF college credit
registration fee of $30/person, camp T-shirt and partial learning material), there is no additional cost to
the selected students at the two-week academy, including food and soft drinks. I understand that the
course of study requires a full-time commitment during the above program period, including daily lessons,
activities, and homework. I understand that I (student) should not take other classes or have jobs during
the above program period without prior written permission. I fully understand the nature of this intensive
program and will abide by its requirements and guidelines. I also understand that submitting this
application does not guarantee my enrollment into the program.


Student name (print) _________________ (signature) ___________________ Date __________


Parent/ guardian (print) _______________ (signature) ___________________ Date __________


Please submit the completed application form and a check of $100 (payable to the University of
South Florida) for registration to the address below. If you are not accepted into the program,
your registration check will be returned. The deadline to submit application is May 13 (Friday),
2011.

        University of South Florida
        Confucius Institute
        4202 East Fowler Avenue, CGS101
        Tampa, FL 33620

        For questions, please contact Chinese@usf.edu.