Preliminary Application

Last Updated—
March 12th, 2012

Desired Program (*required)

First & Last Name (*required)

Phone

Your Email (*required)

Date of Birth

Gender
 Male Female

Marital Status
 Married Single

(If Married) How many Children

Education
Include majors, degrees, clubs

Highest Education

Name of Current College or University

Teaching Experience (if any)
Past experience qualifying you for the position

Do you have a current passport?
 No Yes

Nationality (Country you are from)

Native Language

Teaching Dates
Any Combination

Other Dates?
Please Explain

Preferred Teaching Age

Would you like to be placed with friends or family also applying?

Have you previously visited China for any purpose?
 Yes No

Any known medical/health conditions that would affect your stay in China?

Please describe any previous international travel experience, including each country name, length of stay, and purpose of travel.

Have you ever been convicted of a crime?
 Yes No

Who may we thank for referring you to China Horizons?