Please send to: INTO China Admissions, One Gloucester Place, Brighton, East ... Fax +44 1273 328 595 or +44 1273 329 746
Summer Courses 2013–2014
Representative’s stamp
China application form Please complete all sections of this form in BLOCK Capitals and in BLACK INK and return it to your local representative or direct to the INTO Admissions office. Please send to: INTO China Admissions, One Gloucester Place, Brighton, East Sussex, BN1 4AA, UK Fax +44 1273 328 595 or +44 1273 329 746 Email:
[email protected] You can also apply online at www.intohigher.com/china
Section 1 Student details Title (Mr/Mrs/Ms/Miss)
Country of birth Nationality
Family name
Student’s marital status (must be completed, necessary for visa application)
First given name Name as written on passport
Country of residence
Passport valid till –– /–– /–– (dd/mm/yy)
Address for correspondence
Passport number
Postcode Country Tel. (incl. intl. code)
Country of issue Gender
M
Fax (incl. intl. code)
Mobile tel. (incl. intl. code)
F
Email address
Date of birth –– /–– /–– (dd/mm/yy) Age ––
Mother tongue Other languages
Section 2 Education background
How did you learn about INTO China?
Please give details of your current or most recent school, college or university. Highest educational qualification
High School
College
BA
MA
PHD
Institution name
Friends
Advertisement
Internet*
Through an educational agent*
Subject(s)/major
School/university
Education exhibition*
Other*
* Please state which website or other source or give the name of agency
What is your current level of Chinese?
Beginner
Elementary
Intermediate
What is your current level of English? Beginner
Elementary
Intermediate
Native speaker
Section 3 Where do you want to study?
Dalian (Dongbei University of Finance and Economics) Please tick your preferred start date: 05 Jul 2013 (4 weeks)*
Tianjin (Nankai University) Please tick your preferred start date:
02 Aug 2013 (4 weeks)
07 Jun 2013 (4 weeks)*
05 Jul 2013 (4 weeks)*
Number of additional weeks required
Number of additional weeks required
Beijing (Beijing Foreign Studies University)
Tianjin Junior (Nankai University)
Please tick your preferred start date:
02 Aug 2013 (4 weeks)
Please tick your preferred start date:
02 Aug 2013 (4 weeks)
07 Jun 2013 (4 weeks)
05 Jul 2013 (4 weeks)
Please note no additional weeks are available for juniors. *If you would like to study for more than 4 weeks please specify how many additional weeks of language tuition you require (additional weeks not available for courses beginning on 2 Aug 2012)
Section 4 Accommodation and welfare Single room (en suite)
Twin room (en suite) Not available in Beijing
Completion and signing of this form gives INTO permission to administer first aid by trained staff first aiders if required.
Dietary requirements
INTO China will ensure that all personal data disclosed will only be used to plan appropriate support
Please give details of special dietary requirements e.g. halal, vegetarian, no pork,
for you. It may be necessary for INTO China to disclose appropriate and relevant details to some
any food allergies.
University departments to facilitate this process. I consent to information relating to my personal details, nature of disability and academic
Medical information Do you have any medical conditions?
Yes
No
Please give details of any medical conditions, disabilities or allergies that require attention or notification and any prescribed medicine taken on a regular basis
and support requirements being forwarded as outlined above. Criminal offences P lease tick here if you have been convicted of a criminal offence and supply details on a separate sheet
Section 5 Declaration To be signed by the student or parent/guardian I have read and understood this brochure and agree to abide by the Terms and Conditions
I agree that copies of my academic progress and performance reports can be supplied to sponsors or agents without further notification
I agree to abide by the Cancellation and Refund Policy I agree to pay all tuition and accommodation fees incurred as they become due
SignedDate –– /–– /–– (dd/mm/yy)
I agree that my records and achievements may be used for promotional purposes, without
(Student/parent or guardian if under 18 years of age)
further notification
Note: Please submit a photocopy or scan of your passport details.
