中國(guó)政府獎(jiǎng)學(xué)金申請(qǐng)表

CSC NO.

派遣途徑：

學(xué)生類別：

經(jīng)費(fèi)辦法：

學(xué)習(xí)專業(yè)：

安排院校：1. 2. 3.

中國(guó)國(guó)家留學(xué)基金管理委員會(huì)

CHINA SCHOLARSHIP COUNCIL

中國(guó) 北京復(fù)興門內(nèi)大街160號(hào) 100031

No.160 Fuxingmennei Street, Beijing 100031, P.R.China

Tel: 0086-10-66413253 E-mail: laihua@csc.edu.cn

Fax:0086-10-66413255

（The above table is only for CSC）

中 國(guó) 政 府 獎(jiǎng) 學(xué) 金 申 請(qǐng) 表

APPLICATION FORM FOR CHINESE GOVERNMENT SCHOLARSHIP

請(qǐng)申請(qǐng)人認(rèn)真閱讀本表第四頁(yè)的填表說(shuō)明。請(qǐng)用中文或英文填寫此表格。請(qǐng)用電腦打印或用藍(lán)色或黑色鋼筆認(rèn)真書寫表格內(nèi)容。請(qǐng)?jiān)谒x項(xiàng)框內(nèi)劃‘X’表示。不按規(guī)定填寫的表格將視作無(wú)效。

Please read carefully the important notes on the last page before filling out the form. 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. 申請(qǐng)人情況/Personal Information:

護(hù)照用名/Passport Name: 姓/Family Name: ___________________________________________________ 名/Given Name: ____________________________________________________ 國(guó)籍/Nationality: ________________ 護(hù)照號(hào)碼/Passport No.: __________________ 出生日期/Date of Birth: 年/Year_______月/Month_______日/Day_______ 出生地點(diǎn)/Place of Birth: 國(guó)家/Country:_____________ 城市/City:_____________ 男/Male: □ 女/Female: □ 已婚/Married: □ 未婚/Single: □ 其它/Other: □ 母語(yǔ)/Native Language:_______________________ 宗教/Religion:______________________________________ 當(dāng)前聯(lián)系地址/Present Address:___________________________________________________________________ 電話/Tel: _____________________ 傳真/Fax: _____________________ E-mail: ________________________ 永久通信地址/Permanent Address: _______________________________________________________________

2. 受教育情況/Education Background:

學(xué)校

Institutions

在校時(shí)間

Years Attended (from/to)

主修專業(yè)

Fields of Study

畢業(yè)證書及學(xué)位證書

Certificates Obtained or To Obtain ___________________ _____________________ _____________________ ______________________ ___________________ _____________________ _____________________ ______________________ ___________________ _____________________ _____________________ ______________________

3. 工作經(jīng)歷/Employment Record:

工作單位

Employer

起止時(shí)間

Time (from/to)

從事工作

Work Engaged

職務(wù)及職稱

Posts Held ___________________ _____________________ _____________________ ______________________ ___________________ _____________________ _____________________ ______________________ ___________________ _____________________ _____________________ ______________________

4. 語(yǔ)言能力/Language Proficiency: a).漢語(yǔ)/Chinese: 很好/Excellent □ 好/Good □ 較好/Fair □ 差/Poor □ 不會(huì)/None □ HSK 考試等級(jí)或其他類型漢語(yǔ)考試成績(jī)/ Level of HSK test or other certificates which can show your Chinese level:______________________________________________________________________________

b).英語(yǔ)/English: 很好/Excellent □ 好/Good □ 較好/Fair □ 差/Poor □ 不會(huì)/None □ 我的英語(yǔ)水平可以用英語(yǔ)學(xué)習(xí)/I can be taught in English: 是/Yes □ 否/No □

c).其他語(yǔ)言/Other Languages:___________________________________________________________________

5. 來(lái)華學(xué)習(xí)計(jì)劃/Proposed Study in China:

a).本科生/Bachelor's Degree Candidate: □ 碩士研究生/Master's Degree Candidate: □ 博士研究生/Doctor's Degree Candidate: □ 研究學(xué)者/Research Scholar: □ 漢語(yǔ)進(jìn)修生/Chinese Language Student: □ 普通進(jìn)修生/General Scholar: □ 高級(jí)進(jìn)修生/Senior Scholar: □ b).申請(qǐng)來(lái)華學(xué)習(xí)專業(yè)或研究專題/Subject or Field of Study in China:____________________________________

c).申請(qǐng)?jiān)盒?Preferences of Institutions of Higher Education in China: Ⅰ.________________________ Ⅱ. ________________________ Ⅲ._______________________

d).申請(qǐng)專業(yè)學(xué)習(xí)時(shí)間/Duration of the Major Study: 自/From：年/Year_________月/Month _________ 至/To：年/Year_________月/Month _________ e).是否需要補(bǔ)習(xí)漢語(yǔ)/Do You Need Elementary Chinese Study prior to the Major Study? 是/Yes: □ 請(qǐng)?zhí)顚懮暾?qǐng)漢語(yǔ)補(bǔ)習(xí)時(shí)間（不計(jì)在專業(yè)學(xué)習(xí)時(shí)間內(nèi)）/ If 'Yes', please indicate the duration of your elementary Chinese study(not included in the length of the major study). 自/From：年/Year_______月/Month ________ 至/To：年/Year________月/Month ________ 否/No: □

6. 擬在華學(xué)習(xí)或研究的詳細(xì)內(nèi)容（可另附紙）/ 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. 曾發(fā)表的主要學(xué)術(shù)論文、著作及作品/Academic Papers, Writing & Art Works Published: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

8. 申請(qǐng)獎(jiǎng)學(xué)金類別/Scholarship Applied:

A. 全額獎(jiǎng)學(xué)金/Full Scholarship: □

B. 部分獎(jiǎng)學(xué)金/Partial Scholarship: 學(xué)費(fèi)/Tuition: □ 住宿費(fèi)/Accommodation: □ 醫(yī)療費(fèi)/Medical Care: □ 教材費(fèi)/Learning Materials: □

9. 推薦您申請(qǐng)中國(guó)政府獎(jiǎng)學(xué)金的機(jī)構(gòu)或個(gè)人/Please Specify the Organization or Person Recommending you for this Scholarship: _______________________________________________________________________________

10. 申請(qǐng)人在華事務(wù)聯(lián)系人或機(jī)構(gòu)/The Guarantor Charging Your Case in China:

名稱/Name:_______________________________ 電話/Tel:_________________ 傳真/Fax:_________________

地址/Address:_________________________________________________________________________________

11. 申請(qǐng)人是否曾在華學(xué)習(xí)或任職/Have you ever Studied or Worked in China? 是/Yes: □ 學(xué)習(xí)或任職單位/Institution or Employer: _________________________________________________ 在華時(shí)間/Time in China: 自/From:年/Year_____月/Month _____至/To:年/Year_____月/Month _____ 否/No: □

12. 申請(qǐng)人親屬情況/Family Members of the Applicants: 姓 名 年 齡 職 業(yè) Name Age Employment

配偶/Spouse: __________________________ ______________ _____________________________

父親/Father : __________________________ ______________ _____________________________

母親/Mother: __________________________ ______________ _____________________________ 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

* 所附材料情況（請(qǐng)?jiān)谒礁郊皠潯甔’標(biāo)明）/Materials Attached (Please Indicate with ‘X’in the Bracket.):

□ 兩封推薦信/Two Letters of Recommendation.

□ 有關(guān)中國(guó)院校接受函或錄取通知書/Admission Letter or Admission Notice of Chinese Universities .

□ 本人最后學(xué)歷成績(jī)單復(fù)印件（須公證）/Transcripts of the Most Advanced Studies (Notarized Photocopy).

□ 本人最后學(xué)歷證書復(fù)印件（須公證）/Diploma of the Most Advanced Studies (Notarized Photocopy)：

本科/Bachelor's □ 碩士/Master's □ 博士/Doctor's □ 其它/Others □

□ 外國(guó)人體格檢查記錄（復(fù)印件）/ Foreigner Physical Examination Form (Photocopy).

□ 來(lái)華學(xué)習(xí)計(jì)劃/ Study Plan in China.

□ 所發(fā)表的文章等/ Articles or Papers Written or Published.

□ 美術(shù)作品（本人作品彩照六張）、音樂作品（本人音樂作品盒式錄音帶一盤）（只限申請(qǐng)美術(shù)和音樂專業(yè)的申請(qǐng)人）/Examples of Art (6 color pictures) and Music (1 audio tape) Work (Only for the applicants applying for Fine Arts and Music).

□ 其它附件（請(qǐng)列出）/Other Attachments (List Needed)：__________________________________________________________

注：每份申請(qǐng)材料最多不超過(guò)20頁(yè)，請(qǐng)全部使用A4紙。 Each set of the complete materials should not exceed 20 pages. Please use DIN A4. 無(wú)論申請(qǐng)人是否被錄取，上述申請(qǐng)材料恕不退還。 Whether the candidates are accepted or not, all the application materials will not be returned.

* 申請(qǐng)人保證/I Hereby Affirm That:

1. 申請(qǐng)表中所填寫的內(nèi)容和提供的材料真實(shí)無(wú)誤； All information and materials given in this form are true and correct.

2. 在華期間，遵守中國(guó)的法律、法規(guī)，，不從事任何危害中國(guó)社會(huì)秩序的、與本人來(lái)華學(xué)習(xí)身份不符合的活動(dòng)；

During my stay in China, I shall abide by the laws and decrees of the Chinese government, 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. 來(lái)華后服從CSC所安排的就讀院校和學(xué)習(xí)專業(yè)，不得無(wú)故要求變更學(xué)校和所學(xué)專業(yè)；

I will agree to the arrangements of my institution and specialty of study in China made by CSC, and will not apply for any changes in these two fields without valid reasons.

4. 在學(xué)期間，遵守學(xué)校的校紀(jì)、校規(guī)，全力投入學(xué)習(xí)和研究工作。尊重學(xué)校的教學(xué)安排；

During my study in China, I shall abide the rules and regulations of the host university, and concentrate on my studies and researches, and follow the teaching programs arranged by the university.

5. 按照規(guī)定參加中國(guó)政府獎(jiǎng)學(xué)金年度評(píng)審；

I shall go through the procedures of the Annual Review of Chinese Government Scholarship Status as required.

6. 按規(guī)定期限修完學(xué)業(yè)，按期回國(guó)，不無(wú)故在華滯留；

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.

7. 如違反上述保證而受到中國(guó)法律、法規(guī)或校紀(jì)、校規(guī)的懲處，我愿意接受中國(guó)國(guó)家留學(xué)基金管理委員會(huì)中止或取消獎(jiǎng)學(xué)金及其它相應(yīng)的處罰。

If I am 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 decision of CSC on suspending, or withdrawing my scholarship, or other penalties.

申請(qǐng)人簽字/Signature of the Applicant:______________________________ 日期/Date:___________

（無(wú)此簽名，申請(qǐng)無(wú)效/The application is invalid without the applicant's signature）