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                              WORLD EXCHANGES INC.
                             CHINA TEACHING PROGRAM
                                Application Form

Personal Information

Surname________________________ First Name__________________________  Sex_____

Date of Birth_______________________ Place of Birth___________________________

Mother Tongue_______________ Citizenship____________ Marital Status___________

Present Address_______________________________________________________________

               _______________________________________________________________

E-mail____________________ Telephone___________________ Fax___________________ 

Passport #__________________________________ Expiration Date__________________


Education & Teaching Background

Bachelor's Degree (major)_____________________________________________________

Master's Degree (major) ______________________________________________________

Ph.D. (major) ________________________________________________________________

Full-Time Teaching Experience (where & years) ________________________________

______________________________________________________________________________

______________________________________________________________________________

Emergency & Permanent Contact

Name __________________________________ Relationship _________________________

Telephone___________________ E-mail____________________ Fax___________________ 


I am available to go to China for ____________(Jan/Feb) ___________(September)

I am going to China by _______________ (myself) _____________ (with my spouse)

___________________________________________ name of spouse


I declare that the information I have given in this application is truthful,
complete and correct.

Date______________________________ Signature _________________________________


For Program Use Only

Accepted_________ More documents requested_____________ Not accepted__________