重庆师范大学留学生系统.doc

重庆师范大学 No. CHONGQING NORMAL UNIVERSITY 中国重庆市沙坪坝区大学城中路 37 号 邮编：401331 学生类别 Add: No.37 Da Xue Cheng, Shapingba District, Chongqing ， P.R. 学习专业 China 401331 http://international.cqnu.edu.cn/ 重庆师范大学来华留学生丝路奖学金申请表 APPLICATION FORM FOR CHONGQING NORMAL UNIVERSITY SILK ROAD SCHOLARSHIP 请用中文或英文填写此表格。请用电脑打印或用蓝色或黑色钢笔认真书写表格内容，请在所选项框内划‘X’表示。不按规定 填写的表格将视作无效。 Please complete the form in Chinese or English. If the form is not filled in on PC, please write legibly in black or blue ink. Please indicate with ‘X’ in the blank chosen. Any forms that do not follow the notes will be invalid. 1. 申请人情况/Personal Information 护照用名/Passport Name 姓/Family Name 名/Given Name 国籍/ Nationality 出生日期/Date of Birth: 年/ Year 月/ Month 出生地点/ Place of Birth: 国家/Country 男/Male □ 照片 护照号码/ Passport No. 女/Female □ 已婚/Married Photo 日/ Day 城市/City □ 母语/Native Language 未婚/Single □ 其它/Other □ 宗教/Religion 当前联系地址/ Present Address 电话/Tel E-mail 传真/Fax 永久通信地址/Permanent Address 接 收 录 取 通 知 书 地 址 （ 包 含 国 家 、 省 州 、 城 市 、 街 道 、 邮 编 信 息 ） /Address for receiving admission notice(Street, City, State/Province, Country, Zip code) 2. 受教育情况/Education Background 学校 在校时间 主修专业 毕业证书及学位证书 Institution Years Attended (from/to) Fields of Study Certificates Obtained or To Obtain 3. 工作经历/Employment Record 工作单位 起止时间 从事工作 职务及职称 Employer Time(from/to ) Work Engaged Posts Held 4. 语言能力/Language Proficiency a) 汉语/Chinese: 很好/Excellent □ 好/Good □ 较好/Fair □ 差/Poor □ 不会/None □ HSK 考试等级或其他类型汉语考试成绩/Level of HSK test or other certificates which can show your Chinese level: b) 英语/English: 很好/Excellent □ 好/Good □ 申请授课语言/Language of Instruction：汉语/Chinese 较好/Fair □ □ 我的英语水平可以用英语学习/I can be taught in English: 差/Poor □ 不会/None □ 英语/English□ 是/Yes □ 否 /No □ c) 其他语言/Other Languages: 5. 来华学习计划/Proposed Study in China a) 硕士研究生/Master’s Degree Candidate: □ 本科生/Bachelor’s Degree Candidate: 进修生/Further-study Student □ □ b) 申请来华学习专业或研究专题/Subject or Field of Study in China: c) 申请来华专业学习时间/Duration of the Major Study in China: 自/From: 年/Year 月/Month 至/To: 年/Year 月/Month 6. 拟在华学习或研究的详细内容（可另附纸）/Please describe the details of your study or research plan in China (an extra paper can be attached if this space is not enough) 7. 曾发表的主要学术论文、著作及作品/Academic Papers, Writing & Art Works Published 8. 申请人在华事务联系人或机构/ The Guarantor Charging Your Case in China: 名称/Name: 电话/Tel: 传真/Fax: 地址/Address: 9. 申请人是否曾在华学习或任职/Have you ever Studied or Worked in China? 是/Yes □ 学习或任职单位/Institution or Employer 在华时间/Time in China: 自/From: 年/Year 月/Month 至/To: 年/Year 月/Month 否/No □ 10. 申请人亲属情况/Family Member of the Applicants: 姓名 Name 年 龄 Age 职业 Employment 配偶/Spouse: 父亲/Father: 母亲/Mother: 申请人保证/I Hereby Affirm That: . 1. 申请表中所填写的内容和提供的材料真实无误； All the information and materials given in this form are true and correct. 2. 在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动； During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate in activities in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student. 3. 在学期间，遵守学校的校纪、校规，全力投入学习和研究工作，尊重学校的教学安排； During my study in China, I shall abide by the rules and regulations of the host university, concentrate on my study and researches and follow the teaching programs arranged by the university. 4. 按规定期限修完学业，按期回国，不无故在华滞留； I shall return to my home country as soon as I complete my scheduled program in China and will not extend my stay unreasonably. 5. 我保证，未同时接受其它任何渠道的奖学金或资助； I declare that this is the only Scholarship I am applying for at present. 6. 如违反上述保证而受到中国法律法规或校纪校规的惩处，我愿意接受重庆师范大学中止或取消奖学金及其它相应的处罚。 If I am judged by the Chinese laws, decrees and the rules and regulations of the university for having violated any of the above, I will not lodge any appeal against the decision of Chongqing Normal University on suspending, withdrawing this scholarship or other penalties. 申请人签字/Signature of Applicant: 日期/Date: （无此签名，申请无效/The application is invalid without the applicant’s signature）