201*年赴美國漢語教師志愿者報名申請表(英文)

Hanban-CollegeBoardChineseGuestTeacherProgram

ApplicationFormforChineseTeachers

Placean‘X’inthecheckboxesiftheinformationisTRUE.FamilyNameEnglishName(Ifany)City/ProvinceofBirthMaritalStatusSingleFirstNameGenderMaleFemaleDateofBirth(M/D/Y)MarriedDivorcedPROFESSIONALBACKGROUNDElementarySchoolteacherSeniorMiddleSchoolteacherCurrentPositionJuniorMiddleSchoolteacherCollegeteacherTeacherinotherschool,pleasespecifyOtherPosition,pleasespecifyPrimaryDutiesSchool(Employer)DoesyourcurrentschoolhaveasisterrelationshipwithanyK-12U.S.schools?Yes,TheU.S.sisterschool’sname,cityandstateis:No1.EmployerEnd(M/Y):CollegeCity,ProvincePositionPeriodofFull-timeStart(M/Y):EmploymentLevel(s)TaughtListanddescribeduties2.EmployerMostRecentFull-TimeWorkExperienceElementarySeniorMiddleJuniorMiddleSubject(s)TaughtOther,pleasespecifyEnd(M/Y):CollegeCity,ProvincePositionPeriodofFull-timeStart(M/Y):EmploymentElementaryLevel(s)TaughtListanddescribeduties3.OtherLevel(s)PreviouslyTaught,ifrelevantJuniorMiddleSubject(s)TaughtSeniorMiddleOther,pleasespecifyElementaryJuniorMiddleSeniorMiddleCollegeOther,pleasespecifyIfyouhaveadditionalteachingexperiencenotcoveredhere,pleaseattachextrapages.Ifanyofyourlistedworkexperiencewasnotfull-time,pleaseattachadditionalexplanation.EDUCATIONALBACKGROUNDSchoolNameDatesAttendedEducationalBackground(afterhighschool)Start(M/Y):City,ProvinceEnd(M/Y):DegreeAttained4-yr.Bachelor’sMaster’sMajorOtherListeducationcourseworkSchoolNameDatesAttendedCity,ProvinceEnd(M/Y):DegreeAttainedStart(M/Y):4-yr.Bachelor’sMaster’sMajorOtherListeducationcourseworkIfyouhaveadditionaleducationalexperiencenotcoveredhere,pleaseattachextrapages.CERTIFICATIONSDateObtained:CertificateofTeacherQualificationCertificateofTeachingChineseasForeignLanguageMandarinLevelCertificateofEnglishProficiencyLevelType:College/UniversityVocationalSchoolNoneSecondarySchoolPrimarySchoolNoneOtherSchool,pleaseexplain:YesDateObtained:Level:1A(Highest)Type:1B(Higher)IELTS2A(High)NoneNoneCollegeEnglishTest(CET)TOEFLTestforEnglishMajor(TEM)OtherDateObtained:Level/Score:Yes,obtainedon:ValidPassportYes,expireson:Driver’sLicenseNoNoIflicensed,approximatelyhowmanydrivinghoursperweek?HaveyoueverbeenoutsideofChina?YesNoIfyes,when,where,andforwhatpurpose?AWARDSProfessionaland/orEducationalAwardsReceivedADDITIONALSKILLS/INTERESTSOtherLanguagesOtherSkillsand/orInterestsyouwouldliketoshare(music,sports,games,etc.)PERSONALSTATEMENTPleasedescribewhyyouwanttoteachChineselanguageandculturetostudentsintheUnitedStatesandwhatstrengthsyouwillbringtotheGuestTeacherProgram.(Maximum600characters)PASTVISARECORDHaveyoueverbeenrefusedanyvisatotheUnitedStates?HaveyouevertraveledtotheU.S.onJ-1TeacherVisa?CONTACTINFORMATIONSchoolAddressHomeAddressWorkPhoneHomePhoneEmailAddressEmergencyContactPersonName:Relationship:PostalCodePostalCodeFaxNumberCellPhoneSkypeName(ifany)Address:YesYesNoNoUnsureIfunsure,pleasenametheorganization/programthatsponsoredyouandthepurposeofyourstay.Phonenumber:FAMILYBACKGROUNDRelationshipNameSpouseChildFatherMotherBrother(s)Sister(s)ProfessionPlaceofworkCityProvincePhone#Doyouhaveanyfamilymembersand/orrelativesintheUnitedStates?Yes.No.Ifyes,explainyourrelationtotheperson(s)andtheirimmigrationstatus:ProvincialEducationDepartmentPermission(withstamp)EmployerPermission(withstamp)Bysigningthisform,Icertifythatallinformationprovidedaboveistrueandcompletetothebestofmyknowledge.Iunderstandthatifanyofthisinformationisfoundtobesubstantiallyinaccurateorincomplete,myapplicationtothisprogramwillnotbeconsidered.Signature:_________________________Date:______________________NOTE:1.Fillinallblankswithtrueinformation;2.Attachextrapagesifnecessary.

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