APPLICATION FORM

Name: ____________________________________________ Address: ________________________________________________ City: _______________________ State: _______ Zip: _____________ Home Phone: (____)_____________ Sex: _____ Birthday: _______________

PHOTO HERE

Name: Father _______________________ Mother _______________________

Occupation: Father ______________________________ Mother ___________________________

Business Phones: Father __________________________ Mother _________________________

With whom does applicant live? ________________________ Grades ________________________

School name: _____________________________________ Name of Principal ________________________

Address: ______________________________ City: _________________ State: _____ Zip: _____________

Phone: (___)________________ Mandarin Skill (survival, medium, fluent) _______________________

Special talents or interests ___________________________________________________________________

Name of family physician: _______________________________ Phone: ______________________

SPECIAL NEEDS OR MEDICAL PROBLEMS: _________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

SIGNATURE of APPLICANT _______________________________ Date ____________________

PARENT or GUARDIAN: (print) ________________________ (signature)__________________________