ࡱ> k bjbjz z JbJb%d d 8,<h@ (222&&&$"$H&"&&&22ddd&F22d&dd2`lR 0@ ,% %%&&d&&&&&&&&@ &&&&%&&&&&&&&&d B :   SHAPE \* MERGEFORMAT  New سԹPrincipals Delegation to China 2024 Application Form Personal DetailsFirst name: ____________________________ Surname: ____________________________ Gender: (Male (Female Ethnicity: ____________________________ Date of Birth: ____________ Passport No: ______________ Expiry Date: ______________ School: ____________________________________________________________________ Job title: ___________________________________________________________________ School postal address: ________________________________________________________ ___________________________________________________________________________ Email: _______________________________________ Personal mobile number: _______________________ School phone number: _________________________ School fax number: ____________________________ Applicants home address: ____________________________________________________ __________________________________________________________________________ Home phone number: __________________________ Emergency contact detailsName: _____________________________ Relationship: ___________________________ Phone number: _____________________ Mobile number: _________________________ Email: _____________________________________ Future PlansWhy are you applying for this delegation? How do you plan to use your experience on the tour to contribute to your school on your return? Please attach a separate page to answer this question. Your comments should include reference to the current situation in your school, future directions, curriculum needs, objectives for your students regarding Chinese. Any other information you consider relevant will be helpful for the selection committee as we receive more applications than we are able to accommodate. Other DetailsHave you visited China before? Please give brief details. ___________________________________________________________________________ Do you have any current medical conditions about which the organisers of the tour should be notified? ___________________________________________________________________________ ___________________________________________________________________________ Do you have any special dietary considerations? ___________________________________________________________________________ Declaration by ApplicantIf I am successful in being accepted to join the delegation, I understand that I must comply with the following: Attend a pre-trip meeting, held in Christchurch. Cooperate and participate in all activities during the tour. Purchase my own travel and medical insurance. Complete a feedback form after the tour. Participate in a review of the tour and be available for media interviews on my return to New Zealand. Signature of applicant: ______________________________________________ Date: __________________________________ School Information: School type: ( Primary (Secondary (Composite (Other School Roll: ________________ Currently offering Chinese Classes? (Yes (No Any other comments you wish to make about your school? ___________________________________________________________________________ ___________________________________________________________________________ Board of Trustees Endorsement: I support this application for: ___________________________________________________ Comments: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Name and position on the Board: ___________________________________________________________________________ Signature: ___________________________________________________________________________ School: ___________________________________________________________________________ Date: ____________________________ Referees: Please provide the name, professional title, address and contact phone numbers (include home, work and mobile phone numbers) of two referees who have knowledge of your career background. Name: _____________________________________________________________________ Professional title: ____________________________________________________________ Address: ___________________________________________________________________ ___________________________________________________________________________ Phone number/s: ____________________________________________________________ ___________________________________________________________________________ Name: _____________________________________________________________________ Professional title: ____________________________________________________________ Address: ___________________________________________________________________ ___________________________________________________________________________ Phone number/s: ____________________________________________________________ ___________________________________________________________________________  New سԹPrincipals Delegation to China 2024 Application Form ChecklistInformation requiredTickComplete Application FormCurriculum VitaeNames of two referees with contact detailsCopy of front page of passportTo be returned by Friday, 10 November 2023 to: Ms Qianhua Yu Deputy Director Confucius Institute سԹ Private Bag 4800 Christchurch 8140 Or send email to Ms Qianhua Yu, Deputy Director, at  HYPERLINK "mailto:qianhua.yu@canterbury.ac.nz" qianhua.yu@canterbury.ac.nz Tel: 03 369 3383     New سԹPrincipals Delegation to China 2024 Application Form  PAGE \* MERGEFORMAT 4 +,-./0=[\_`aqr{|帯vmdmXLChp5CJaJh"hp5CJaJh?({hp5CJaJh5z\5CJaJhr@5CJaJhBXhp56CJ aJ h?({hp56CJ$aJ$hS5CJ$aJ$hx05CJ$aJ$h95CJ$aJ$o(h95CJ$aJ$h?({hp5CJ$aJ$jhFY5CJ$UaJ$%jhr5CJ$UaJ$mHnHuhr5CJ$aJ$jhr5CJ$UaJ$hp0ar5 % lbbbbb dgdpwkd$$Ifl#$  t 0644 lap ytvKQd$IfgdvKQ$a$gdpgdli F G H a b c + , 3 4 7 8 9 :  7:@AGH567i¶¤™¶zzԍrirrh[5CJaJhpCJaJh[CJaJhphpCJaJhphp5CJaJh95CJaJo(h5z\5CJaJhr5CJaJh"hp5CJaJh?({hp5CJaJhr@5CJaJhli5CJaJh15CJaJhp5CJaJ joh hpCJaJ)% u O   G H b c owkd8$$Ifl#$  t 0644 lap ytvKQd$IfgdvKQ dgdp c + , 9 : :HmcV $da$gdli $a$gd5z\zkd$$Ifl#$  t 0644 lap ytvKQd$IfgdvKQ dgdp HI7Kd}}}}}}}od$IfgdvKQ dgdliwkd$$Ifl#$  t 0644 lap ytvKQ 1JKZ[cduLMRvw~T᪲Ö|sh5Y5CJaJh Vhp5CJaJ joh hpCJaJh"hp5CJaJhliCJaJh/CJaJh5YCJaJhp5CJaJh?({hp5CJaJh5z\5CJaJhr@5CJaJhpCJaJhphp5CJaJhphpCJaJ-de FuMvqqqqqaV h^hgdphdx^hgdli & Fdxgdligdpwkd5$$Ifl#$  t 0644 lap ytvKQ vwT ngggggggdpwkd$$Ifl#$  t 0644 lap ytvKQd$IfgdvKQ h^hgdp  bcnRs!ms"Z_*/v`oȽԝԕԄ{rhp5CJ$aJ$hr5CJ$aJ$ jhxvhrUmHnHuhrCJaJh[CJaJh"hp5CJaJhlihp5CJaJhli5>*CJaJhWhp5CJaJhpCJaJhIhpCJaJhIhp5CJaJh?({hp5CJaJ) bcnRs!mgdpwkd$$Ifl#$  t 0644 lap ytvKQmYZD)*rh $a$gd5z\wkd-$$Ifl#$  t 0644 lap ytvKQd$IfgdvKQgdp *v`5FP$$Ifa$gdvKQ$a$gdpgdp345FPSmn(ʾtkbZRhCbCJaJhlCJaJh15CJaJhx05CJaJh95CJaJo(h95CJaJhCb5CJaJhC5CJaJh5Y5CJaJhE-hp5CJaJhm$hpCJaJhphm$hp5CJaJh?({hp56CJ$aJ$hC5CJ$aJ$hx05CJ$aJ$hp5CJ$aJ$h; hp5CJ$aJ$PQR| $IfgdvKQwkdS$$Ifl#$  t 0644 lap ytvKQRShm$$Ifa$gdvKQhkdS$$Ifl#$ t0644 laytvKQmnyy $IfgdvKQ{kd3T$$Ifl0#W t0644 laytvKQyy $IfgdvKQ{kdT$$Ifl0#W t0644 laytvKQyy $IfgdvKQ{kd9U$$Ifl0#W t0644 laytvKQyy $IfgdvKQ{kdU$$Ifl0#W t0644 laytvKQ)9Ngy#}ttttttoooogdE^gdpgdp{kd?V$$Ifl0#W t0644 laytvKQ ("#$%&()+,./1@A`aƾƦƾғ툄|x|x|x|xtplhtdt\jhvKQUhlihChx0hFhvKQhijhiUh@Sgh VhpCJaJhr@CJaJhEhr@CJaJh|hr0JCJaJhEhrCJaJhrCJaJjhrCJUaJhCCJaJhEhECJaJhECJaJhpCJaJhE-hpCJaJ$#$%'(*+-.01$a$ dgdpgdph@SghijhvKQU*h(ATmHnHujhvKQUhvKQ21h:pvKQ. 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