Name: (Please type your name exactly as it appears on your passport) First: Middle: Last: Gender: male female
Applying for: Summer English Teaching Program Long Term English Teaching Program Chinese Language Immersion Program Academic Touring Program Other(Please specify below)
1. Contact Information ( If any of this information will change please let us know in the "Personal Comments" section. )
Street Address: City: State: Zip Code: Home Phone: Other Phone: E-mail: Please re-enter E-mail:
In an emergency, we should contact: Name: Phone: E-mail:
2. Background
Date of birth: Place of birth:
3.Sources How did you hear about us? Flyer/Poster Internet Newspaper Friend Recruiter Name of the person who referred you:
4. Short-Answer Questions:
Have you ever traveled out of the US before, where and how was the experience?
How can you be a good teacher? Please share some of your ideas toward education:
Why do you want to do this program and what are your expectations?
Personal Comments(Optional): 5. Resume: On Resume please include:
Personal photograph Education history Work history Volunteer history Two professional references (Note: Recommendation letters are not necessary for the summer program) Attachment 1: Attachment 2: Attachment 3:
Note: Some large attachments may have trouble being sent. If you have any trouble filling out the application or attaching the resume or photo please copy and paste your responses, your resume or your photo and send them by email to applications@act-center.org