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Summer Programs

Student Application Form Chinese Immersion Summer Day Camps for Ohio Students

June 16 – 27 (9:00am-5:00pm), 2008
The Ohio State University K-12 Chinese Flagship Program

1. Personal Information

Name _______________________________ Date of Birth _______/_______/_______

Place of Birth (City, State, Country) _____________________________________________________________________

Sex: Male ___ Female ___

Home Address _________________________________________________________________

City _____________________ Zip Code _____________ County ___________________

Telephone (home) ___________________________ Cell Phone ___________________________

E-mail address (Please print clearly) ________________________________________________

Your current grade level at school (only 6-12th graders are eligible): _______________________

Name and address of your school: __________________________________________________

2. Language Background

All applicants should have at least basic Chinese language background, but their first language is not Chinese. List any foreign language courses you have taken, including Chinese courses:

What do you consider to be your native language? ____________________________________

What language is spoken most frequently in your home? ________________________________

Have you ever lived or studied in a country other than the U.S.? Yes ___ No ___

If yes, where and for how long? ____________________________________________

3. If you are not a native speaker of Chinese, provide the following information.

Evaluate your own ability in Chinese according to the scale below. (Circle your response.) (3 = High, 2 = Above average, 1 = Low, X = unknown)

Ability to engage in daily conversation: 3 2 1 X

Ability to communicate in a variety of situations: 3 2 1 X

Ability to read newspapers and magazines: 3 2 1 X

Ability to write effectively: 3 2 1 X

4. Reference

If you are currently not enrolled in a Chinese language class in a K-12 school, please ask someone (not a relative) who can rate your level of Chinese language to provide a reference letter for you. If you are currently enrolled in a Chinese language program, please submit the application to your teacher of Chinese, who will provide a reference for you.

5. Statement of Understanding

The OSU K-12 Chinese Flagship Program provides intensive Chinese Immersion Summer Day Camps (in the metro areas of Cleveland, Columbus and Dayton) during June 16--27, 2008 at no cost to students and peer mentors, including food and materials (not including transportation). I understand that the course of study requires a full-time commitment during the above program period, including eight hours of lessons and activities at a high school (including lunch hour) and homework each day. I understand that I (student) should not take other classes or have jobs during the above program period without prior written permission. I fully understand the nature of this program and will abide by its requirements and guidelines. I also understand that submitting this application does not guarantee my enrollment into the program.

Student’s signature ________________________________________ Date _____________

Parent/ guardian’s signature _________________________________ Date _____________

Please submit the completed application form to your teacher of Chinese or your school principal. Priority will be given to applications submitted by April 11 (Friday), 2008. If your school does not have a Chinese language program (but you have basic Chinese background), you may submit your completed application by email to StarTalkChinese@osu.edu, by fax to 614-292-3194, or by regular mail to:

OSU K-12 Chinese Flagship Program
2941 Kenny Road, Suite 200
Columbus, OH 43221

If you have questions about this application form or the Summer Day Camp, please contact your teacher of Chinese, or send an email to StarTalkChinese@osu.edu.

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