ASU Chinese Language Flagship Application Contact Information

ASU Chinese Language Flagship Application
Contact Information
Name
Local Address
City, State, ZIP Code
Permanent Address
City, State, ZIP Code
Home Phone
Cell Phone
Email Address
Date of Birth (MM/DD/YY)
Gender
Country of Birth
Country of Citizenship
Academic Information
Student ID (#1000)
Residency Status
Year in School
College / Department
Major / Minor
Expected Graduation
GPA
Pre-professional Program
Extracurricular Activities
Please use this space to list some of your interests and extracurricular activities.
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Chinese Language Background
Please describe your Chinese language learning background.
School Name / City, State
Years of Study
Elementary
Middle School
High School
Chinese School
Other
Are you a heritage speaker of any Chinese dialect?
No
□
Yes
□
Dialect:______________
Please list your current and most recent Chinese courses taken.
School
Course
Instructor
Have you taken any tests to evaluate your Chinese language such as: STAMP, HSK, CCALT or Webcape?
Date of Completion
Score
STAMP
HSK
CCALT
Webcape
OPI
Other:____________
Other Language Background
Do you speak any other language(s)? If so, please fill out the following information for that language.
Language(s):_____________________________
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School Name / City, State
Years of Study
Elementary
Middle School
High School
University
Foreign-Language
School
Other
Have you taken any tests to evaluate those languages?
Test
Date of Completion
Score
Letters of Reference
In addition to this application we require two letters of reference, one of which must be
recommendation form from a language instructor who can speak to your Chinese language ability and
classroom performance and one of which should be a letter from a faculty member in the department
of your major. The letters may be emailed to [email protected], or mailed to our program
at:
On-Campus Mail
Chinese Language Flagship Program
Arizona State University
Mail Code: 1202
Tempe, AZ 85287
Off-Campus Mail
Chinese Language Flagship Program
Arizona State University
PO Box 871202
Tempe, AZ 85287-1202
Please list below your references:
Name
Address
City, State, ZIP Code
Phone
Relationship to Applicant
Name
Address
City, State, ZIP Code
Phone
Relationship to Applicant
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Writing Sample
Please provide a handwritten writing sample of around 150-180 Chinese characters according to the
following prompt and attach this to your application:
Suppose someone introduces you to a Chinese friend who is moving to Arizona to attend ASU. What
would you tell this student about living in Arizona and attending ASU to help them prepare?
Statement of Purpose
As part of this application please type a 500-1000 word statement of purpose (in English) detailing your
reasons and goals in applying to this program. Please attach your statement of purpose to your
application.
Transcripts
Please include an unofficial copy of your most recent ASU transcripts. If submitting any transcripts from
other schools please use official transcripts.
Emergency Contact
Name
Address
City, State, ZIP code
Home Phone
Cell Phone
Email Address
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a Flagship student, any false statements, omissions, or other
misrepresentations made by me on this application may result in my immediate disqualification.
Name (printed)
Signature
Date
Our Policy
It is the policy of this program to provide equal opportunities without regard to race, color, religion,
national origin, gender, sexual preference, age, or disability.
Thank you for completing this application form and for your interest in joining our program.
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Instructor Recommendation Form
Please rate the candidate. Your candid assessment of the applicant will greatly assist us in
making the best decision for the applicant and the program. Please complete this form along
with a letter on your official letterhead stationery and mail or email to us at
[email protected] We appreciate your time and effort in providing us this information.
Applicant’s Last or Family Name
First
Middle
Would you recommend this candidate for the ASU Chinese Language Flagship/ROTC Program?
Please explain.
Please comment on the student’s ability to succeed in intensive Chinese language study.
Please comment on the student’s Chinese language proficiency.
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Please comment on the student’s level of maturity.
Please use this space to describe any other aspect of the candidate’s behavior, learning style, or
any other topic you think is appropriate.
Name (printed)
Signature
Date
Email
Completed letters and forms may be emailed to [email protected], or mailed to our program
at:
On-Campus Mail
Chinese Language Flagship Program
Arizona State University
Mail Code: 1202
Tempe, AZ 85287
Off-Campus Mail
Chinese Language Flagship Program
Arizona State University
PO Box 871202
Tempe, AZ 85287-1202
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