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Register Online ATTENTION: If you apply for Homestay Only, please register here.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. Indicate your state Alabama Alaska Arizona Arkansas California Colorado Connecticut Florida Delaware Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Oklahoma Ohio Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming State or region outside of the U.S. * Country Indicate your country Andorra Angola Antarctica Argentina Aruba Australia Austria Bahamas Bangladesh Belgium Bolivia Brazil Bulgaria Cameroon Canada Cape Verde Chile China Colombia Costa Rica Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador England Estonia Fiji Finland France French Polynesia Gambia Germany Ghana Gibraltar Greece Greenland Guadeloupe Guatemala Guinea Haiti Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kenya North Korea South Korea Latvia Liechtenstein Lithuania Luxembourg Malaysia Malta Mauritius Mexico Monaco Morocco Netherlands New Zealand Norway Northern Ireland Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Romania Russian Federation San Marino Scotland Singapore South Africa Spain Sweden Switzerland Taiwan Tanzania Trinidad and Tobago Tunisia Turkey Ukraine United Kingdom United States Uruguay Venezuela Virgin Islands (British) Virgin Islands (U.S.) Wales Yemen Yugoslavia Other   Zip code * Phone number Country code   area code   prefix   suffix   Cell number Country code   area code   prefix   suffix   * Email address   * confirm email address   * Gender Indicate your gender male female   * Date of birth month January February March April May June July August September October November December day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   year 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 * Place of Birth   Passport # * Passport valid until month January February March April May June July August September October November December day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 * Nationality (citizenship)   Religion * Emergency contact person   * Relationship   * Phone number Country code   area code   prefix   suffix   Name of school or university currently attending Please indicate your major and grade Employment History:(Job Title, Employer, Dates of Employment, etc.) Name of medical insurance carrier: Policy number: Course Information * Please indicate which program you prefer Choose Program College Programs High School Programs Summer Study and Travel One-On-One Tutoring Business Chinese Program Volunteer and Teach Program   * Please indicate which start-finish date you prefer: month January February March April May June July August September October November December day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   year 2009 2010 2011 2012 2013 2014 2015       month January February March April May June July August September October November December day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   year 2009 2010 2011 2012 2013 2014 2015 * Please indicate your Chinese language level:  Please indicate beginner intermediate advanced   * How long have you been studying Chinese?   Please indicate beginner about 3 month about 1 year over 1 year   * How many Chinese characters you can recognize?   Please indicate very few around 100 around 500 around 1000   Please describe specific course requirements or fields of interest within your program: What are your expectations or goals you hope to achieve through this program? What do you want to do most while you stay with Lotus? Why? Homestay Information (For detailed info about our host families, see Host Family and FAQ) * Where would you prefer to live ? With a host family near the campusWith a host family in another area of BeijingHost family in downtown areaI don't mind any location* Do you mind sharing the bathroom with your host family? Yes I mindNo, I don't mind sharing * Do you smoke?   yesno * Do you mind a family with a preschool-age child ?  yesno * Do you mind a family with pets?  yesno * Are you interested and qualified to apply for our Teach and Stay Program?(Please note that these spaces are limited, and are first come, first served) yesno * If teach and stay exchange is not available, would you still be willing to join our program?  yesno Please list any allergies, health problems, or foods that you can not eat: Please indicate a few of your hobbies or special interests: Please indicate your personality and lifestyle: What do you expect from your host family? What sort of family personalities suit you best? Use the space provided below for any additional detail about yourself. 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   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 408-884-2429 or download the registration form, fill it out and send it to reg@lotuseducation.org. Type Verify Code:           Copyright © 2002-2008 Lotus Educational Foundation All rights reserved Lotus Educational Foundation 1173-D South De Anza Blvd. San Jose, CA 95129, USA Tel: 1(408) 996 1929 Beijing Office: 86-10-8287 2866 Email:info@lotuseducation.org inquiry@homestay.com.cn