中国人 Chinese 请填写此表格，CAMBA 员工将与您联系.每个家庭只需填写一份表格，并提供尽可能多的信息.请允许我们在两周内与您联系. 我们将根据列表中提供的信息与您联系. 谢谢您的理解！Complete only one form per household, and provide as much information as possible. Question Title * 1. 名First Name Question Title * 2. 姓Last Name Question Title * 3. 电邮地址（如果没有电子邮箱，请填写：x）*Email (If you don’t have an email please type: x)* Question Title * 4. 电话号码Phone Number Question Title * 5. 您的住址是什么：（街道、城市、纽约州）*What is your address: Street, City, NY Question Title * 6. 您是在什么时候到达美国的？When did you arrive in the United States? Example: 12/31/2005 Question Title * 7. 您是否拥有以下任何一项移民身份？What is your current immigration status? 人道主义特许入境 - 阿富汗（AHP）Afghan Humanitarian Parolee 人道主义特许入境 –乌克兰（UHP)Ukrainian Humanitarian Parolee 人道主义特许入境 - 海地（HHP）Haitian Humanitarian Parolee (HHP) 古巴/海地入境者（CHE)Cuban/Haitian Entrant (CHE) 难民（REF)Refugee 庇护受益人（ASY）Asylee 美亚混血儿（AMR)Amerasian 特别移民签证（SIV)Special Immigration Visa holder 人口贩运受害者（VOT)Victim of Human Trafficking (VOT) 其他Other Question Title * 8. 您的英文程度如何？（选一）What is your level of English? 无None 很少Minimal 良好Good 流利Fluent Question Title * 9. 在接下来的三个月内，我需要有工作I need to work in the next 3 months: 是Yes 否No Question Title * 10. 我愿意担任初级的工作职位: I am willing to work an entry level position: 是Yes 否No Question Title * 11. 您需要哪些方面的帮助（填空）What help do you need? (Fill in the blank) 我们会在两周以内根据您所提供的信息联系您。谢谢您！Please allow us up to two weeks to contact you. We will contact you according to the information provided on the list. Thank you for understanding! Done