CSST Summer Program 2019
Application Part 1


Name Please enter your name exactly as it appears on your passport. If you apply for a passport later, please remember to write your name exactly the same way as you have entered it here.

Last (Family) Name:

First (Given) Name:

English Name (optional):

Permanent Address

(Please provide a residential address; not a school, dorm, or office address):

Street Address 1:

Street Address 2:

City:

Province/County/State:

Country:

Postal Code:

Day telephone:

Evening telephone:

Email Address: 

(Please use an email address that you check frequently, and can be accessed away from your university or outside your home country.)

Alternate Email Address: 

(Please use an email address that you check frequently, and can be accessed away from your university or outside your home country.)

Personal Information

Gender:  Male  Female  

What is your marital status?  Single  Married  Divorced  Widowed

Do you have a U.S. Social Security Number:  Yes   No

Birth Date (Month/Day/Year): / /

City of birth:

Province/County/State of Birth:

Country of birth:

Country of Permanent Residence:

Country of Citizenship:

What is your passport number:

Expiration Date: (Month/Day/Year): / /

I do not have a passport
Visa Information Are you currently on a U.S. visa? No Visa Visa waiver F-1 J-1 Other: Please Specify

If yes, please provide your SEVIS ID#

Emergency Contact

Name(In the U.S. or in home country.):

Relationship to you (mother, father, etc.):

Address 1:

Address 2:

City:

State/County/Province:

Country:

Postal/Zip Code:

Day Telephone:

Evening telephone:

E-mail:

Academic Background

School Name:

If not listed, please type in:

Major Category:

Major:

Expected Degree Completion Date (mm/dd/yyyy):

Courses in Progress: (List only courses that do not appear on your official transcript.)

Course 1 Name (English):

Credits:

Course 2 Name (English):

Credits:

Course 3 Name (English):

Credits:

Course 4 Name (English):

Credits:

Course 5 Name (English):

Credits:

Course 6 Name (English):

Credits:

Course 7 Name (English):

Credits:

Course 8 Name (English):

Credits:

Course 9 Name (English):

Credits:

Course 10 Name (English):

Credits:

Course 11 Name (English):

Credits:

Course 12 Name (English):

Credits:

Course 13 Name (English):

Credits:

Course 14 Name (English):

Credits:

Course 15 Name (English):

Credits:

Undergraduate GPA/Ranking

Please use http://www.foreigncredits.com/Resources/GPA-Calculator/ to calculate your GPA. Select Country -> United States.

Year 1: Overall GPA Major GPA Ranking in degree program Number of Students in program

Year 2: Overall GPA Major GPA Ranking in degree program Number of Students in program

Year 3: Overall GPA Major GPA Ranking in degree program Number of Students in program

Year 4: Overall GPA Major GPA Ranking in degree program Number of Students in program

Year 5: Overall GPA Major GPA Ranking in degree program Number of Students in program

English Proficiency Test I have not taken an English proficiency test (skip to next section)

I have taken the National English Test in China

English Level 4: Test date (mm/dd/yyyy) Score

English Level 6: Test Date (mm/dd/yyyy) Score

I have taken another English proficiency test (e.g. TOEFL, GRE, IELTS)

Test Name 1:

Test Date 1 (mm/dd/yyyy)

Test Score (List the score for each skill, e.g. Reading 20, Writing 20, etc.)

Test Name 2:

Test Date 2 (mm/dd/yyyy)

Test Score (List the score for each skill, e.g. Reading 20, Writing 20, etc.)

Research Experience

Have you ever participated in a research program?

If yes, please provide your research experiences below:

If no, but you will have research experience by June 2019, please provide the information below:

Experience 1:

Department/Organization name:

Program/experience name:

Dates you participated (mm/dd/yyyy): from to

Mentor name:

Mentor title:

City:

State/County/Province:

Country:

Experience description: (1000 character limit)

Experience 2:

Department/Organization name:

Program/experience name:

Dates you participated (mm/dd/yyyy): from to

Mentor name:

Mentor title:

City:

State/County/Province:

Country:

Experience description: (1000 character limit)

Experience 3:

Department/Organization name:

Program/experience name:

Dates you participated (mm/dd/yyyy): from to

Mentor name:

Mentor title:

City:

State/County/Province:

Country:

Experience description: (1000 character limit)

Please check the accuracy of the information that you have entered. You will have an opportunity to review and edit your application after clicking 'Continue'. You will not be able to make changes after clicking 'Submit'.