Tri-Cities Mandarin Initiative

Please complete this form to indicate interest in ENROLLING in the Mandarin Bilingual program in Tri-Cities (Coquitlam, Port Coquitlam, Port Moody, Anmore & Belcarra). Your responses are very important to help us quantify the demand for this program in School District 43.

On completion of this survey/sign-up, your email address will be added to our mailing list for email updates. If you wish to be removed from the mailing list, please send an email to us with "unsubscribe" in the subject line.

Our privacy policy is available at the bottom of this page.

Email: tricitiesmandarin@gmail.com
Web: www.MandarinForBCSchools.org

1. Please Tell Us Who You Are

First Name Required Question

Last Name

Email Address Required Question

Postal Code Required Question

Phone Number

2. Where Do You Reside? Required Question

3. Your child(ren) will enter school in the following. Check all that apply.
(If you have twins, please make a note in Other field.) Required Question

	Kindergarten in 2010 (born in 2005)
	Grade 1 in 2010 (born in 2004)
	Grade 2 in 2010 (born in 2003)
	Kindergarten in 2011 (born in 2006)
	Kindergarten in 2012 (born in 2007)
	Kindergarten in 2013 (born in 2008)
	Other

4. If a Mandarin Bilingual program is launched in the Tri-Cities area, would you ENROLL your child(ren)? Required Question

	Yes
	No
	Maybe

5. Please let us know if you would like to help:

6. How did you hear about us? Required Question

7. Comments/Feedback/Suggestions

Privacy Policy. All personal information gathered on this form will be kept in the strictest confidence and will not be shared or used for purposes outside of the MandarinForBCSchools.org mandate as described on the website. Any information that may be shared will be done so as "aggregate non-personal information" - information that is recorded about users and collected into groups so that it no longer reflects or references an individually identifiable user. If we use this information in a manner different than the purpose for which it was collected, then we will ask for your consent prior to such use.

	Admin
	E-Mailing
	General Telephoning
	Flyer/Poster Distribution
	Legal
	Research
	Website
	Other (please specify)

	Coquitlam
	Port Coquitlam
	Port Moody
	Anmore
	Belcarra
	Other