Shanghai Summer School 2011 Application

Name

 Family Name                 Given Name

Photo

（Paste here）

Chinese Name

Male/Female

Date and Place of Birth

National

Passport No．

School or company

Primary Telephone:

MP:

Email

Permanent Home Address

Educational Background

Name of School                

Date of attendance from／to

Diploma or Degree Obtained

Specific area of Study

Where & how long have you studied Chinese or other related Chinese Culture?