Volunteer Program

* fields are compulsory

Program A (3 days)          Program B (10 days)    
First day: day month year Last day: day month year
 
Which Volunteer/Service Learning Program are you applying for? *
 
Please select your program dates *:
 
Personal Information
NAME: First * Middle: Last: *
Date Of Birth: day month year
Sex: M F
Contact e-mail:
Home Phone: ( ) -
Contact Phone: ( ) -
Home Address  
Street:
City:
State:
Postal code:
Country:
Contact Address(If different from the home address above)
Street: *
City: *
State: *
Postal code: *
Country: *
   
Citizenship *
Ethnicity:
If non-U.S. Citizen, Visa Type:
   
Education Level
Occupation
 
EMERGENCY CONTACT INFORMATION
Emergency Contact 1  
Name:                   *
Phone: ( ) - *
Address: *
Relation: *
   
Emergency Contact 2  
Name:                  
Phone: ( ) -
Address:
Relation:
   
OTHER REQUIRED INFORMATION
Have you ever been to China? Yes No     
If yes, how much total time have you spent in China?    
Chinese language ability:
Do you have a valid passport? Yes No
Do you have health insurance 
for international travel?		 Yes No   (You must have international travel    insurance to participate on Abroad China's programs)
Do you have any pre-existing 
medical conditions or disabilities?		 Yes No
 If yes, please explain 
How did you hear of us?
Internet Monstertrak.com
Goabroad.com Studyabroad.com
Career center Study abroad office
Business school Chinese class
Faculty Study abroad fair
Past participant Friends
Other     ,  please specify 
 
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