North American Chinese Educational Foundation

^{Application Form for Internship}

^{1. Name________________________________________________________________________}

                      ^{(first name) (middle name) (last name)}

^{2. Sex : Male______Female________}

^{3. Date of Birth ______/ _______/ ________Mo. Day Year}

^{4.Place of Birth__________________________________________________________________}

                                         ^{(City) (State) (Country)}

^{5. Social Security Number (if applicable)______________________________________________}

^{6. Citizenship___________________________________________________________________}

^{7. Ethnic Group (optional)}

^{____ Black, non-hispanic _____Asian or Pacific Islander ______Hispanic/Latino}

^{______American Indian _______White, non-hispanic}

^{Other (be specific):___________________________________________________}

 

^{8. Address_____________________________________________________________________}

                  ^{(number & street) (Apt.No)}

^{_______________________________________________________________________________}

                  ^{(city) (state/province)}

^{_______________________________________________________________________________}

                  ^{(Zip/postal code) (country)}

^{9. Telephone____________________________________________________________________}

                                          ^{(day)                                   (evening)}

^{10. Fax_________________________________ E-mail_______________________________}

^{11. Education}

^{List in chronological order all post-secondary schools attended.}

^{________________________________________________________________________________}

^{(name of school) (Dates Attended)}

^{_________________________________________________________________________________}

^{(major) (degree received)}

^{________________________________________________________________________________}

^{(name of school) (Dates Attended)}

^{_________________________________________________________________________________}

^{(major) (degree received)}

^{________________________________________________________________________________}

^{(name of school) (Dates Attended)}

^{_________________________________________________________________________________}

^{(major) (degree received)}

^{________________________________________________________________________________}

^{(name of school) (Dates Attended)}

^{_________________________________________________________________________________}

^{(major) (degree received)}

^{13. Attach a one-page resume of your education, work experience, academic honors, professional recognitions, published writings, and other relevant information.}

^{14. Write a brief statement of purpose of why you want to join our project.}