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Gender (required): Male Female	Date of birth (DD/MM/YYYY):
Email address (required):	Nationality:
Home address:
Home phone number:	Mobile phone number (required):
Have you studied with us before?: Yes No	If "Yes", which year did you study?:

What is your level of Chinese?: (Please estimate or take a quick test to find out): Total Beginner Lower Beginner Middle Beginner Upper Beginner Lower Intermediate Middle Intermediate Upper Intermediate Advanced

If you are not a total beginner, please describe your prior learning experience (e.g. "I have studied for one year, every day for three hours"):

I plan to start on (DD/MM/YYYY):	I plan to finish on (DD/MM/YYYY):

What course type do you want to apply for?: Intensive Small Group Private, 1 on 1 Private, 1 on 2 Combined Course Part-time Small Group Other

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