Questionnaire for China Education Services Program

Thank you for taking this questionnaire. This questionnaire should take approximately 5-10 minutes. Your responses will provide important information to help us improve our service to you. You can also download the questionnaire here and return it to our Wanchai office at Rm. 1102, 11/F, Methodist House, 36 Hennessy Rd., Wanchai, H.K..

Contact Name *
Email address *
Tel / Mobile *
Office phone no.
Name of Student (English)
Name of Student (中文)
Age	SexM F
Student's Nationality
Student's Ethnic
Family Primary Language
Second Languages
College / School / Kindergarten attended
Current Level of Mandarin in speaking, listening, reading and writing
Type of our China Program (please tick)	Mandarin Short Term Immersion Program Festival Mandarin Program Mandarin & Activities Camp Mandarin Program in College in China Tailor Made Program by Request* Mandarin Examination preparation *Please specify if you choose the Tailor Made Program & Mandarin Examination
Preferred City (please tick)	Beijing Xi'an Shanghai Other *Please state the city if you tick Other:
Proposed season and time duration suit you	Season in days
Proposed Departure Date and Proposed Return Date (DD/MM/YY)	Departing on / / Returning on / /
Please state your expectation on the program (Course required and aim)
Please enter any additional comments here (any self travel arrangement, lodging arrangement, identity of travel companion or any request about the stated issue? Etc.)

For further enquiries, please feel free to contact us
Tel: 852 - 2865 1660
Fax: 852 - 2865 1630
Email: beijing@netvigator.com