ASU Chinese Language Flagship Application Contact Information Name Local Address City, State, ZIP Code Permanent Address City, State, ZIP Code Home Phone Cell Phone Email Address Date of Birth (MM/DD/YY) Gender Country of Birth Country of Citizenship Academic Information Student ID (#1000) Residency Status Year in School College / Department Major / Minor Expected Graduation GPA Pre-professional Program Extracurricular Activities Please use this space to list some of your interests and extracurricular activities. 1 Chinese Language Background Please describe your Chinese language learning background. School Name / City, State Years of Study Elementary Middle School High School Chinese School Other Are you a heritage speaker of any Chinese dialect? No □ Yes □ Dialect:______________ Please list your current and most recent Chinese courses taken. School Course Instructor Have you taken any tests to evaluate your Chinese language such as: STAMP, HSK, CCALT or Webcape? Date of Completion Score STAMP HSK CCALT Webcape OPI Other:____________ Other Language Background Do you speak any other language(s)? If so, please fill out the following information for that language. Language(s):_____________________________ 2 School Name / City, State Years of Study Elementary Middle School High School University Foreign-Language School Other Have you taken any tests to evaluate those languages? Test Date of Completion Score Letters of Reference In addition to this application we require two letters of reference, one of which must be recommendation form from a language instructor who can speak to your Chinese language ability and classroom performance and one of which should be a letter from a faculty member in the department of your major. The letters may be emailed to [email protected], or mailed to our program at： On-Campus Mail Chinese Language Flagship Program Arizona State University Mail Code: 1202 Tempe, AZ 85287 Off-Campus Mail Chinese Language Flagship Program Arizona State University PO Box 871202 Tempe, AZ 85287-1202 Please list below your references： Name Address City, State, ZIP Code Phone Relationship to Applicant Name Address City, State, ZIP Code Phone Relationship to Applicant 3 Writing Sample Please provide a handwritten writing sample of around 150-180 Chinese characters according to the following prompt and attach this to your application: Suppose someone introduces you to a Chinese friend who is moving to Arizona to attend ASU. What would you tell this student about living in Arizona and attending ASU to help them prepare? Statement of Purpose As part of this application please type a 500-1000 word statement of purpose (in English) detailing your reasons and goals in applying to this program. Please attach your statement of purpose to your application. Transcripts Please include an unofficial copy of your most recent ASU transcripts. If submitting any transcripts from other schools please use official transcripts. Emergency Contact Name Address City, State, ZIP code Home Phone Cell Phone Email Address Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a Flagship student, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate disqualification. Name (printed) Signature Date Our Policy It is the policy of this program to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in joining our program. 4 Instructor Recommendation Form Please rate the candidate. Your candid assessment of the applicant will greatly assist us in making the best decision for the applicant and the program. Please complete this form along with a letter on your official letterhead stationery and mail or email to us at [email protected]. We appreciate your time and effort in providing us this information. Applicant’s Last or Family Name First Middle Would you recommend this candidate for the ASU Chinese Language Flagship/ROTC Program? Please explain. Please comment on the student’s ability to succeed in intensive Chinese language study. Please comment on the student’s Chinese language proficiency. 5 Please comment on the student’s level of maturity. Please use this space to describe any other aspect of the candidate’s behavior, learning style, or any other topic you think is appropriate. Name (printed) Signature Date Email Completed letters and forms may be emailed to [email protected], or mailed to our program at： On-Campus Mail Chinese Language Flagship Program Arizona State University Mail Code: 1202 Tempe, AZ 85287 Off-Campus Mail Chinese Language Flagship Program Arizona State University PO Box 871202 Tempe, AZ 85287-1202 6