Personal Information
First Name*
 Last Name* Middle Name
Date of Birth*
 Day Month Year Gender*
Street / Apt. No.*
City*
 State / Province*
Country*
 Zip / Postal Code*
Nationality*
 Native Language
Passport Number*
Educational Level*
Occupation*
Current Employer /
Institution*
Home Phone*
Work Phone
Mobile Phone
Fax
Email*
Program Details
City Selection*
Beijing Shanghai Xi’an Qingdao
Nanjing Tianjin Guangzhou Tibet
Hangzhou Dalian Kunming  
University Applying for*

Beijing Language and Culture University (Beijing)
Peking University (Beijing)
Tsinghua University (Beijing)
Renmin University of China (Beijing)
Beijing Academy of Chinese Studies (Beijing)
The University of International Business & Economics (Beijing)
Beijing Sport University (Beijing)
Fudan University (Shanghai)
Shanghai Jiaotong University (Shanghai)
Xi’an Jiatong University (Xi’an)
Tianjin University (Tianjin)
Nanjing University (Nanjing)
Zhejiang University (Hangzhou)
Yunnan University (Kunming)
Ocean University of China (Qingdao)
Dalian University of Technology (Dalian)
Guangdong University of Foreign Language Studies (Guangzhou)
Tibet University (Tibet)

Program Title*
 Chinese Language
Chinese Business & Language
Martial Artsl
Marital Arts & Language
Chinese Language & Internship
Tailored 1-on-1 Language
DIY Chinese Study Adventure
Summer Camp
Homestay Only
Study and Travel
Teach in China
Program Start
Date*
 Day Month Year
Program End Date*
 Day Month Year
Program Duration*
Have you previously studies
the Chinese Mandarin
language?*
 Yes No
If Yes, please state the
name of the institution /
school
What Is Your Current Level
of Chinese*
Are you receiving credit for
this course from your
university?
 Yes No
If Yes, how many credits?
Accommodation
Accommodation Option(for
Tuition Only Program
please select “None
None”)*
No. of Extra Nights
Accommodation Start Date
 day month year
Accommodation End Date
 day month year
Do You Smoke?*
 Yes No
Do You Prefer to Live in A
Smoke-free Room or
Family?*
 Yes No
Additional Comments (
eg. Joint Additional-state
name or joint Applicant)
Emergency Contact
Name*
Relationship to Applicant*
Emergency Home Phone*
Emergency Work Phone
Emergency Fax
Emergency Email*

I declare that: 
I agree with the declarations
stated above:
 yes no
Electronic Signature of Applicant or Parent (for ages 17 and under)
Type Initial Here
Before submitting the registration form, please print it out for your record. If you can't make on-line submission, please fax the printed form to us
at 1-604-456-0261 or download the Application Form, fill it out and send it to admission@realworldchinese.com .
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