Application Form for Immersion Hub 2017 Short Term International Student Program

First Name on Passport *

Last Name on Passport *

Chinese Name

Gender *
FM

Marital Status *
MarriedSingle

Date of Birth *

Place of Birth *

Nationality *

Scanned personal information page of passport(no larger than 4Mb) *

Passport No. *

Passport Valid Until *

Email Address *

Employer or School Affiliated *

Post Address for Acceptance Letter and JW202 Form *



Phone Number (With international code) *

Qualifications and General Educational Background

Undergraduate


Postgraduate
Master



Doctor


Self-assessment on your Chinese level
Chinese: NoneBeginnerIntermediateAdvanced
HSK Grade :
I have studied Chinese for Months

Do you have special dietary requirements? *
YesNo
For who chosed yes, please specify here:

Room Type of Student Dormitory *
Double RoomSingle RoomMake your own accommodation arrangement

I hereby affirm that:
1) All of the information on this form is accurate to the best of my knowledge.
2) I shall abide by the laws of the government of P.R. China and the regulations of the Shanghai Open University

Contact

4F Learning World Plaza, No.288 Guoshun Road, Shanghai China
Post Code: 200433
Tel: (86 21) 25653006
Fax: (86 21) 25653267
Email: iieoffice@sou.edu.cn