汉语桥夏令营教师申请表
Application Form for Chinese Bridge Summer Camp Chaperons
请用英文提供以下信息，并打印。/ Please provide following information and type in
English.
1. 申请人情况/Personal information： 护照名/Passport Name: ___________________________
姓/Last Name: __________________________________
名/Given Name: _________________________________
出生日期/Date of birth: ___________________________
国籍/Nationality: ___________ 性别/Gender: 男/Male 女/Female 护照号码/Passport #: __________________________________
护照有效期/Passport Expiration Date: ____________________
职务/Position: ________________________________________
单位/Institution: ______________________________________
工作地址/Work Address: _______________________________
办公电话/Office Phone: _____________ 传真/Fax: ____________
办公邮件Work Email: _________________________________
2. 紧急联络人信息
联络人1/Contact #1
姓名/Name: _____________ 家庭电话/Home Phone: ____________________
办公电话/Office Phone: __________ 手机
/Cell Phone: ___________________
联络人2/Contact #2
姓名/Name: ______________ 家庭电话/Home Phone: ___________________ 办公电话/Office Phone: ____________手机/Cell Phone: __________________
3. 医疗信息/Medical Information
1) 你目前是否在接受治疗？/Are you currently receiving medical treatment? 是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________
2) 你目前是否在接受心理咨询或治疗？/Are you currently receiving counseling
or medication for any psychological or emotional conditions?
是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________ ________________________________________________________________
3) 你是否有任何过敏？/Do you have any allergies?
是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________ 4. 请附上简历/Please attach your CV
申请人声明/Declaration of applicant:
我特此证明:/ I hereby certify that:
本表所填写的内容和提供的材料真实无误/ All the information on this form is true and correct.
汉语桥夏令营教师申请表
Application Form for Chinese Bridge Summer Camp Chaperons
请用英文提供以下信息，并打印。/ Please provide following information and type in
English.
1. 申请人情况/Personal information： 护照名/Passport Name: ___________________________
姓/Last Name: __________________________________
名/Given Name: _________________________________
出生日期/Date of birth: ___________________________
国籍/Nationality: ___________ 性别/Gender: 男/Male 女/Female 护照号码/Passport #: __________________________________
护照有效期/Passport Expiration Date: ____________________
职务/Position: ________________________________________
单位/Institution: ______________________________________
工作地址/Work Address: _______________________________
办公电话/Office Phone: _____________ 传真/Fax: ____________
办公邮件Work Email: _________________________________
2. 紧急联络人信息
联络人1/Contact #1
姓名/Name: _____________ 家庭电话/Home Phone: ____________________
办公电话/Office Phone: __________ 手机
/Cell Phone: ___________________
联络人2/Contact #2
姓名/Name: ______________ 家庭电话/Home Phone: ___________________ 办公电话/Office Phone: ____________手机/Cell Phone: __________________
3. 医疗信息/Medical Information
1) 你目前是否在接受治疗？/Are you currently receiving medical treatment? 是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________
2) 你目前是否在接受心理咨询或治疗？/Are you currently receiving counseling
or medication for any psychological or emotional conditions?
是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________ ________________________________________________________________
3) 你是否有任何过敏？/Do you have any allergies?
是/Yes 否/No
如果是，请解释/If yes, please explain_________________________________ 4. 请附上简历/Please attach your CV
申请人声明/Declaration of applicant:
我特此证明:/ I hereby certify that:
本表所填写的内容和提供的材料真实无误/ All the information on this form is true and correct.