申请人基本信息 Personal Information

姓 Family Name

名 Given Name

性别Sex

  Photo

照 片

国籍Nationality

出生日期D.O.B.

护照号码Passport No.

YYYY-MM-DD

本人通讯地址、电话及邮箱

Correspondence address, telephone number and Email address

ADD:

TEL:

EMAIL:

主要教育经历（从高中开始）Major education experience(Start from senior high)

校名

School names

在校时间

Time (from/to)

主修专业

Major fields of study

取得学位证书

Diploma

工作经历Work experience

工作单位Organization  

工作时间 Time (from/to)

职位Position

来黔留学计划 Proposed study in Guizhou

申请高校

Preferences of Institutions in Guizhou

第一志愿

First Choice

第二志愿

Second Choice

学习专业/研究领域

Majors or fields of study/research

学习时间

Duration of the major study

自/From: 年/Year      月/Month     

至/To: 年/Year      月/Month

我希望申请

I want to apply for

□职业培训项目Vocational training programs    

□专科生Vocational education programs   

□本科生 Bachelor programs　     

□硕士生 Master programs            

□博士生 Doctoral programs

新HSK考试等级或其他类型汉语考试成绩Level of New HSK Test or other Certificates which can show your Chinese Level:

是否需要汉语补习Do you need Elementary Chinese Study prior to the major study?    □是Yes   □否No

所附材料说明（请在所附附件前划“×”标明）：

Materials Attached (Please indicate with “×” in the check.):

□ 护照复印件/A Photocopy of the Candidate’ s Passport;

□ 最后学历、学位证书复印件/ A Photocopy of Diploma or Certificate of the Most Advanced Studies;

□ 健康证明/ Health Check Report;

□ 来黔学习/研究计划/Study/Research Plan in China;

□ 在华法定监护人有效证明的复印件/A Photocopy of the Prove of the Candidate’ s Legal Supervisor ( can be a passport, license, or other official ID);

□ HSK证书复印件/ A Photocopy of HSK Certificate.

申请人保证　I  hereby  affirm  that

上述各项中所提供的情况是真实无误的。All the information filled in the form is true and correct.

在华学习期间遵守中国政府的法律和学校的规章制度。I shall abide by the laws and decrees of the Chinese government and school regulations.

如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受中止或取消奖学金及其它相应的处罚。If I am judged by the Chinese laws and decrees as well as the rules and regulations of the university as having violated any of the above, I will not lodge any appeal against the decision on suspending, or withdrawing my scholarship, or other penalties.

申请人签字Applicant’s signature:                              日期Date: