Chinese Language Declaration Form
Please complete the Chinese Language Declaration Form to provide your proficiency, usage context, and declaration details.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Chinese Dialect
*
Please Select
Mandarin
Cantonese
Shanghainese
Hokkien
Other
Chinese Language Proficiency Level
*
Beginner
Intermediate
Advanced
Native/Fluent
Years of Chinese Language Study
*
Main Contexts of Chinese Language Use
*
Personal
Professional/Work
Academic/Study
Travel
Other
Frequency of Chinese Language Use
*
Daily
Weekly
Monthly
Occasionally
Self-Assessment of Chinese Skills
*
Rows
Beginner
Intermediate
Advanced
Native/Fluent
Reading
1
2
3
4
Writing
5
6
7
8
Speaking
9
10
11
12
Listening
13
14
15
16
Declaration Statement (Please describe your Chinese language experience and purpose for this declaration)
*
Date of Declaration
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Declaration
Should be Empty: