STUDENT APPLICATION FORM FOR INTERNSHIP PROGRAMS IN CHINA


Name:(Last)    (First)    (Middle)   
Institution of Enrollment:   
Signature:    Date:   

Background Information
PRIMARY CONTACT INFORMATION

Cellular Phone Number(s) E-Mail Address(es)
Campus Number Permanent Phone Number
Fax Number Local or Work Phone Number

ADDRESS(ES)

Campus or Local Address (P.O. Box or Street, City, State, Zip Code)
Permanent Address (If Different Than Above)
Name of Spouse (If Applicable)

Academic Information

Current Academic Classification ( Freshman, Sophomore, Junior, Senior, Graduate)
JSU Student ID Number (J-Number)
Department/Program and College/School of Enrollment
Academic Major/Area of Study (Also List Any Relevant Minors or Areas of Concentration)
Type of Degree Sought
Anticipated Vocation
Cumulative Grade Point Average
Anticipated Date of Graduation
Name and Address of Department/Program Chair
Telephone/Fax Numbers and E-Mail Address for Department/Program Chair
Financial aid/ scholarship awarded
Length of taking Mandarin Chinese

Personal Information

Social Security Number Date of Birth
Gender Name of Health Insurance Plan and ID Number
Special Dietary or Medical Conditions Name, Address and Number(s) of Primary Physician
Name(s) and Address of Parent(s) or Legal Guardian(s) Telephone Numbers of Parent(s) or Legal Guardian(s)

Passport Information

Country of Citizenship Passport Number and Country of Issuance
Date of Expiration Number of Blank Pages

Internship Interests
Please indicate the type of internship program(s) in which you are interested by placing a check in the appropriate box(es):

Cooperate Internship:    Service-Learning:   

Are you interested in joining a university-based student association China Initiatives University Club that will work with the Office of China Initiatives to promote participation in internship programs by the broader student body? (Yes or No)

Certification
By providing a signature on the front page of this document, applicant certifies that the information contained in this document is accurate to the best of his/her knowledge.