1、西班牙漢語(yǔ)年大中學(xué)生夏令營(yíng)學(xué)生申請(qǐng)表Student Application Form for The Year of Chinese in Spain Summer Camp for Spanish Students of High Schools and Universities 照片Photo請(qǐng)用西班牙語(yǔ)回答下面的問(wèn)題（電腦打印或用正楷填寫(xiě)）/ Please provide information about yourself below in Spanish. Please print照片Photo1. 申請(qǐng)人情況/Personal information： 姓/Surame(apell

2、ido): _名/ firstname(nombre): _出生日期/Date of birth: _ 國(guó)籍/Nationality: _ 性別/Gender: 男/Male FORMCHECKBOX 女/Female FORMCHECKBOX 護(hù)照號(hào)碼/Passport #: _ 護(hù)照有效期/Passport Expiration Date: _ 第一語(yǔ)言/First Language:_ 第二語(yǔ)言/Second Language:_ 家庭成員華文背景/Chinese Background of Family Members:_ _2. 學(xué)校信息/School information學(xué)校名稱

3、/School Name: _ 年級(jí)/Grade: _學(xué)校地址/School Address: (including zip code)_ 3. 緊急聯(lián)絡(luò)人信息聯(lián)絡(luò)人1/Contact #1姓名/Name: _ 家庭電話/Home Phone: _辦公電話/Office Phone: _ 手機(jī)/Cell Phone: _聯(lián)絡(luò)人2/Contact #2姓名/Name: _ 家庭電話/Home Phone: _辦公電話/Office Phone: _ 手機(jī)/Cell Phone: _4. 漢語(yǔ)水平/Chinese Language Proficiency:是否學(xué)過(guò)中文？/Do you learn

4、Chinese already? 是/Yes FORMCHECKBOX 否/No FORMCHECKBOX 如果是，學(xué)習(xí)中文多長(zhǎng)時(shí)間？/ If yes, how long have you been learning Chinese?_中文水平/Chinese Language Proficiency (Basic, Intermediate, Advance): _是否來(lái)過(guò)中國(guó)?/Have you been to China before? 是/Yes FORMCHECKBOX 否/No FORMCHECKBOX 如果是，上次在中國(guó)多長(zhǎng)時(shí)間?/If yes, how long did you

5、 stay in China last time? _ 5. 醫(yī)療信息/Medical Information1) 你目前是否在接受治療？/Are you currently receiving medical treatment? 是/Yes FORMCHECKBOX 否/No FORMCHECKBOX 如果是，請(qǐng)解釋/If yes, please explain_ 2)你目前是否在接受心理咨詢或治療？/Are you currently receiving counseling or medication for any psychological or emotional conditi

6、ons?是/Yes FORMCHECKBOX 否/No FORMCHECKBOX 如果是，請(qǐng)解釋/If yes, please explain_ 3)你是否有任何過(guò)敏？/Do you have any allergies?是/Yes FORMCHECKBOX 否/No FORMCHECKBOX 如果是，請(qǐng)解釋/If yes, please explain_ 6. 請(qǐng)陳述申請(qǐng)參加夏令營(yíng)的原因。（請(qǐng)附詳細(xì)說(shuō)明，最多250字）/Please state the reasons why you would like to participate in the Summer Camp (Please a

7、ttach a separate sheet, maximum 250 words).7. 請(qǐng)附上貴校教師推薦信一封并提供推薦人信息/Please attach a letter of reference for your application by one teacher from your school. List the referee information below:姓名/Name 聯(lián)系電話或郵箱/Phone or Email 職務(wù)/Title_ _ _8. 申請(qǐng)人聲明/Declaration of applicant:我特此證明:/ I hereby certify that:本表所填寫(xiě)的內(nèi)容和提供的材料真實(shí)無(wú)誤/ All the in