ATTENTION: Before completing this form, please read Registration & Payment Procedure carefully and thoroughly.
 
Personal Information
(All information will be kept confidential. For more info see our privacy policy)
 * First name
 * Last name

 * Street Address
 * City

 State in the U.S.
 State or region outside of the U.S.

 * Country
 Zip code

 * Phone number
 Country code
 area code
 prefix
 suffix
 cell number
 Country code
 area code
 prefix
 suffix

 * Email address
 * confirm email address
 * Gender

 * Date of birth

* Place of Birth


 Passport #
 * Passport valid until

* Nationality (citizenship)
Religion

 * Emergency contact person
*  Relationship

 * Phone number      
 Country code
 area code
 prefix
 suffix

 Name of school or university currently attending

 Employment History:(Job Title, Employer, Dates of Employment, etc.)

 * What is your purpose to attend the Chinese language program
Please specify

 
Course Information
 
* Please indicate which course you prefer

* Please indicate which start-finish date you prefer:
    

 *Please indicate your Chinese language level:

 Please tell us about any specific course of study that you want to pursue or any special requirements that you may have:

  Homestay Information
(For detailed info about our host families, see Host Family and FAQ)

 * Where would you prefer to do a homestay ?
Host family near the campus Host family downtown or other part of Beijing

 * Do you prefer homestay with a private bathroom for you?
yes don't mind sharing

* Do you smoke? Yes No
 
* Do you mind a family with a preschool-age child ? Yes No
 

* Do you mind a family with pets? Yes No
 

* Are you interested and qualified to apply for our Free Homestay Package?(Please note that these spaces are limited, and are first come, first served)
Yes No
 

* If a free homestay is not available, would you still be willing to join our program?
Yes No
 

Please list any allergies, health problems, or foods that you can not eat.

Please indicate a few of your hobbies or special interests. We will try to match these with a host family

Use the space provided below for any additional detail about yourself. Also, please specify if you have a preferred family after searching our database

How did you hear about Lotus?
Please specify

 
TERMS AND CONDITIONS
By initialing below, I agree that I have read the program information, understand and accept the conditions under which these programs will be conducted, particularly those which apply to the program cost, and refund policy. I understand that the program cost includes administrative expenses, and hereby release Lotus, their agents, employees or representatives from all actions suits, claims, or liability for damages arising out of my participation in the program. I confirm that I have also read the "Notice of Understanding Between Participant and Lotus"
Please type initial here
 
Copyright 2002-2005 Lotus Educational Foundation All rights reserved
Lotus Educational Foundation
1173 South De Anza Blvd. Suite D
San Jose, CA 95129, USA
Tel:
(408) 996 1929
Email:info@lotusstudy.com