广西科技大学国际学生申请表Guangxi University of Science and Technology Application Form for Intern….doc

广西科技大学国际学生申请表 Guangxi University of Science and Technology Application Form for International Students 外文·姓 Surname 外文·名 Given Name 中文姓名 Chinese Name 国籍 Nationality 男/Male □ 女/Female □ 未婚/Single □ 已婚/Married □ 出生日期/Date of Birth 出生地点/ Place of Birth 贴相片处 宗教信仰 Religion 职业 Occupation 年/Year 月/Month 国家/Country： paste photo 日/Day 城市/City： 护照号码 Passport No. 护照有效期 Date of Expiration 最后学历 Highest Education 联系电话 Mobile Number 年/Year 月/Month 日/Day 邮箱 E-mail 申请类别（请在方格内打“X” ）Category of students (please mark the appropriate box with a cross) □汉语进修生 □普通进修生 □ 高级进修生 Chinese Language Student General Advanced Students Senior Advanced Student □本科生 □ 研究生 Undergraduate Postgraduate 申请学习专业 Major Applied for in GXUST 申请学习时间 Duration of Study 自/From: 年/Year 月/Month __ _年/Year ______月/Month 拟到校学习日期 Proposed Arrival Date at GXUST 永久通讯地址及电话号码 Permanent Address and Telephone Number 国家/County： 目前通讯地址及电话号码 Current address and Telephone Number 国家/County： 至/To: 年/Year 月/Month _____ 日/Day 城市/City：_______________ 街道/Streets 邮政编码/Postal Code： __________ 电话/Cell.No.： 城市/City：_____________________ 街道/Streets ______________________________________________________ 邮政编码/Postal Code： 电话/Cell.No.：__________________ 紧急联系人（可以是父母或亲戚朋友，国籍不限） Emergency contact during your stay at GXUST(Contact person can be a parent or relative of applicants) 姓名/Name： 电话/Tel： 与申请人关系/Relationship to the applicant： 手机/Cell： 在华事务联系人（或监护人）/ Contact Person（or Guardian） in China 姓名/Name： 与申请人关系/Relationship to the applicant：_____ 电话/Tel： 手机/Cell： 1 教育背景/Education Background 校名 School 在学时间 Dates of Study 主修专业 Major Fields of Study 取得证书 Qualifications 工作经历/Work Experience 工作时间 Date 工作地点及单位 Place 职位 Position 经费来源/Source of Finance □自费 担保人姓名/Name of Financial Sponsor： 电话/传真 Tel/Fax： Self-support 地址/Address： □校际交换 学校名称/University name： 电话/传真 Tel/Fax： University exchange 联系人/Contact person： 邮箱/E-mail： □拟申请奖学金 □校奖学金 GXUST scholarship Scholarship □其他奖学金 你所具备的汉语基础 Describe Your Backgrounds of Chinese Language Other scholarship 听力 Listening： □很好/Excellent □好/Good □较好/Average □差/Poor □不会/None 会话 Speaking： □很好/Excellent □好/Good □较好/Average □差/Poor □不会/None 阅读 Reading： □很好/Excellent □好/Good □较好/Average □差/Poor □不会/None 写作 Writing： □很好/Excellent □好/Good □较好/Average □差/Poor □不会/None HSK 考试等级/Level of HSK test： 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/School or Employer: 在华时间/Time in China: 自/From: 年/Year 月/Month 至/To: 年/Year 否/No □ 申请人亲属情况/ Family Members of the Applicants: 姓名/Name 年龄/Age 职业/Employment 配偶/Spouse: 父亲/Father: 母亲/Mother: 兄弟/Brothers : 姐妹/Sisters: 2 电话/Phone 月/Month 其他需要说明的情况/Further Information： 申请人保证 I hereby affirm that 1．上述各项中所提供的情况是真实无误的。 All the information filled in this form is true and correct. 2．在华学习期间，遵守中国法律、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的活动。 During my stay in China, I shall abide by the laws and decrees of the Chinese government and school regulations, and will not participate in any 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 the study in China, I shall abide by the rules and regulations of the host university, and concentrate on my studies 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，不能无故在华滞留。 I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid reasons. 5. 如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受相应的处罚。 If I judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above, I will not lodge any appeal against the penalties. 6. 按照学校规定在注册时缴纳学费、住宿费、报名费等其他费用并自觉在中国境内购买留学生综合保险。中 途辍学或被开除学籍者，已交付的相关费用概不退还。 I shall pay the tuition fee, accommodation fee, registration fee and any other fees and buy the Comprehensive Insurance for Foreigner Staying in China by myself before/when I register. I notice that no fees which I paid before will be refunded if I drop off or be dismissed from school. 申请人签字/Applicant’s Signature 日期: Date: 年/YY 月/MM 日/DD 备注 Note 1．申请时请寄来：①学位证书/毕业证书复印件。②在华逗留三个月以上者提供正式医院出具的有效健康证 明（自签发之日起半年内有效） 。③护照复印件。 Please enclose: ① Two copies of transcripts. ② Those to stay in China 3 months or above should provide a statement of health and physical condition(6 months validity from the date of issue) from a medical doctor on his/her letterhead, when you mail this form. ③Photocopy of your passport. 2. 来校注册时需交近期护照规格照片十张（短期留学生交五张） 。 Ten most recent passport sized photos will be needed at registration/Five photos for short-term students. 3. 以上表格必须认真填写，每项内容必须填写，没有的内容请写“无”；表格内容不全者将不予受理。 The form must be full filled out carefully without any omission. If your situation does not fit in, please write “None” at the space. The incomplete form will not be accepted. 填好本表后请按下列地址邮寄 中国 广西柳州市 东环大道 268 号 广西科技大学 国际合作与交流处 Please return the completed form to the address below: Office of International Cooperation and Exchanges Guangxi University of Science & Technology 268 Donghuan Avenue, Liuzhou Guangxi 545006 P. R. China 推荐人/Referred by: 3 Tel/Fax: +86-772-2687357 Email: gxustadmissions@163.com gxutgjc@126.com Website: http://www.gxust.edu.cn