邢唷��>� X[��W��欹�a ��>;bjbj*�*� 8FH�=bH�=b3 ��**��>>>��搁搁搁8�<��,R�? ��011???????$B�糄p5?�>&1�0镑�0&1&15?��?�3�3�3&1��濒>?�3&1?�3�3谤�<�T,{=��嘭~M^嬖��1r�<��>�?0�?=z,E23�,E{=,E>{=€&1&1�3&1&1&1&1&15?5?�3&1&1&1�?&1&1&1&1��,E&1&1&1&1&1&1&1&1&1*Bl: Name: ___________________________________ Student ID # __________________________ Faculty you are in: _________________________ �% Other:_________________________ Degree sought ________ what year are you in: ______________________ �% Other Major _______________________ Minor ________________________________________ Previous degree/diploma: _________________ when:_______________________________ Do you plan to take East Asian studies as your major? �% Yes �% No Do you plan to take East Asian studies as your minor? �% Yes �% No Would you be interested in the Summer Chinese language Program in China? �% Yes �% No Personal/educational background: Place of birth: __________________________ Year of birth: ________________________ Where did you attend elementary school? ________________________________________ Where did you attend junior/senior high school? ___________________________________ Where did you complete Grade 12 or senior high school? _________________When? ______ Did you attend a Chinese-English bilingual program in Canada? �% Yes �% No If yes, which school? ____________________________ Which grades? _____________ Did you attend an after school Chinese program? �% Yes �% No If yes, when?________ How long? ____________ Did you take Chinese in elementary/secondary school? �% Yes �% No If yes, which courses? ________________________ Have you ever been to or resided in any place(s) in Asia? �% Yes �% No If yes, where__________________ from when ___________ to when ______________ If you were not born in North America, when did you come? ______________ �% Other______________________________________________________________ Language of instruction for schools you attended before you came to North America? _______ Chinese language and culture courses taken: What Chinese language courses have you taken at the U. of 喵咪社区/elsewhere, and when? 1)_________________2)__________________3)____________________ What Chinese language courses are you currently taking at the U. of 喵咪社区/elsewhere? 1)_________________2)__________________3)____________________ What Chinese culture courses have you taken at the U. of 喵咪社区/elsewhere, and when? 1)_________________2)__________________3)____________________ Language(s) and dialect(s) spoken: What language(s) and dialect(s) can you speak other than English? French: ________________ 2) Mandarin: ________________ Cantonese: ________________ 4) Other(s): _________________ ________________ What language(s) do you speak at home? _________________________________ Do your parent(s) speak Chinese? �% Yes �% No If yes, what dialect(s) �% Mandarin �% Cantonese �% Other______ Knowledge of Chinese characters: If you haven t taken Chinese language courses at the U of Alberta, do you know Chinese characters at all? �% Yes �% No If yes, please �� & T ~ € � � � � ��(*,.06:<>@��黹爿籽搜菅潘两阉逊鲍Й褷褮柦栄殩雅褠褮柦栄殩雅褮栄叛殩雅 h�)�CJh�x h�xCJ h鮗CJo(h�! h�!CJ h'P�CJ h{n�CJhI�hg(| hI�CJ hg(|CJ h鮗CJ ha�CJ hH~�CJ h3�CJh鮗$jhY � C��<��勦`勦G$gd鞮<�劯凥⺈D8�^劯`凥�凘劺⺗凘`劺龷d鳱p$a$�� " < > ��)*+*��$04<DTV\^bfnrt�� "*>bjp� 脞兮旺曲曲历捍喊窗代代曲曲谴按按按按潳苞 h鸆�CJo( h鸆�CJ h睝�CJh鐍€ h鐍€CJ h_�CJ h_�CJo( h�CJhH~�hH~�5丆J\�h葿5丆J\�h鮗5丆J\�hH~�hH~�CJ h�/CJ h鮗CJ>�*�(�Z��V��,-��(h��gd77 &Fgdrs| &FG$gdF_Agd��G$gd鞮<�勦^勦gdH~�gd鸆� 06\j��X\b��b��BD��,-��/0AEHIVgs��痍痄疔鹫鹧鹚酿舅葛漯铂牟默震痍站攷鹫鹫饚厊�hrs|h睝�CJhrs|h鮗CJ hrs|CJ h覢CJh鮗5丆J\�h3�5丆J\� h��CJ h葿CJ hH~�CJ hF_ACJ h��CJo( h,p CJhI� hI�CJh鸆�h�CJ h�CJ h睝�CJ h鮗CJh鐍€ h鐍€CJ/��$LNPTVfjnp��*b*d*f*z*|*�*�*�*�*�*�*+++++黝麇哔酉铀淤哔咔线燎线燎线吝腐擤擤哔擐擤龠贈曔懴戇嬞 h攂�CJh攂� hI�CJ h覢CJ hIc�CJU h騏fCJh鮗5丆J\�h3�5丆J\� h橲�CJh橲�hwh�h77 hwh�CJ h77CJ h鮗CJhrs|h鮗CJhrs|h睝�CJhrs|hI�CJ6��*2+�+P,T,V,X,Z,\,^,`,b,d,f,j,l,n,p,r,t,,-.-�-��gdq�$a$gd77 estimate your level of using Chinese characters: __________ and ____________ Where did you learn the Chinese characters? �% In school �% At home Please indicate if you know: �% Traditional characters �% Simplified characters �% Pinyin �% Zhuyin (bo po mo fo) Student Declaration: I have read and understood the screening and placement decision above. Student signature:________________________ Date:__________________________ Department of East Asian Studies Chinese Language Program Student Language Background Questionnaire (March 2015) Page PAGE \* MERGEFORMAT 1/2 This questionnaire is to provide background information for the screening and placement for all CHINA language courses. Due to the characteristics of language acquisition, specific information about your background is needed for an accurate assessment of your language ability. Please answer the relevant questions accurately and fully; and write N/A if the question is not applicable to you. The department reserves the right to discontinue anyone from a class should his/her level be found to be higher than what is claimed on this questionnaire. I certify that the information in this form is true and complete in all respects and that I have withheld no information. I understand that misrepresentation, falsification of documents, or withholding of requested information regarding this application are serious offences and may result in prosecution under the University s Code of Student Behavior. Student information is collected under the authority of the Universities Act in accordance with Alberta s Freedom of Information and Protection of Privacy Act for the purpose of determining eligibility. For further details, see 23.9 of the University of Alberta Calendar or contact the Department of East Asian Studies, 780-492-2836. 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