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1 中国国家留学基金管理委员会 CHINA SCHOLARSHIP COUNCIL 中国北京车公庄大街 9 号 A No.9 A3-13 chegongzhuang Street, Beijing P.R.China100044, Tel: laihua@csc.edu.cn Fax: CSC NO. 派遣途径 : 学生类别 : 经费办法 : 学习专业 : 安排院校 : (The above table is only for CSC) 中国政府奖学金申请表 APPLICATION FORM FOR CHINESE GOVERNMENT SCHOLARSHIP 请申请人认真阅读本表第四页的填表说明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 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. 申请人情况 /Personal Information: 护照用名 /Passport Name: 姓 /Family Name: 名 /Given Name: 照片 Photo 国籍 /Nationality: 护照号码 /Passport No.: 出生日期 /Date of Birth: 年 /Year 月 /Month 日 /Day 出生地点 /Place of Birth: 国家 /Country: 城市 /City: 男 /Male: 女 /Female: 已婚 /Married: 未婚 /Single: 其它 /Other: 母语 /Native Language: 宗教 /Religion: 当前联系地址 /Present Address: 电话 /Tel: 传真 /Fax: 永久通信地址 /Permanent Address: 2. 受教育情况 /Education Background: 学校 Institutions 在校时间 Years Attended (from/to) 主修专业 Fields of Study 毕业证书及学位证书 Certificates Obtained or To Obtain 3. 工作经历 /Employment Record: 工作单位 Employer 起止时间 Time (from/to) 从事工作 Work Engaged 职务及职称 Posts Held

(The above table is only for CSC) 中国政府奖学金申请表 APPLICATION FORM FOR CHINESE GOVERNMENT SCHOLARSHIP 请申请人认真阅读本表第四页的填表说明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

2 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: 较好 /Fair: 差 /Poor: 不会 /None: 我的英语水平可以用英语学习 /I can be taught in English: 是 /Yes 否 /No c). 其他语言 /Other Languages: 5. 来华学习计划 /Proposed Study in China: a). 本科生 /Bachelor s Degree Candidate: 硕士研究生 /Master s Degree Candidate: 博士研究生 /Doctor s Degree Candidate: 汉语进修生 /Chinese Language Student: 普通进修生 /General Scholar: 高级进修生 /Senior Scholar: b). 申请来华学习专业或研究专题 /Subject or Field of Study in China: c). 申请院校 /Preferences of Institutions of Higher Education in China: Ⅰ. Ⅱ. Ⅲ. d). 申请专业学习时间 /Duration of the Major Study: 自 /From: 年 /Year 月 /Month 至 /To: 年 /Year 月 /Month e). 是否需要补习汉语 /Do You Need Elementary Chinese Study prior to the Major Study? 是 /Yes: 请填写申请汉语补习时间 ( 不计在专业学习时间内 )/ If Yes, please indicate the duration of your elementary Chinese study(not included in the length of the major study). 否 /No: 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. 申请奖学金类别 /Scholarship Applied: A. 全额奖学金 /Full Scholarship: B. 部分奖学金 /Partial Scholarship: 学费 /Tuition: 住宿费 /Accommodation: 医疗费 /Medical Care: 教材费 /Learning Materials: 9. 推荐您申请中国政府奖学金的机构或个人 /Please Specify the Organization or Person Recommending you for this Scholarship: 10. 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:

英语 /English: 很好 /Excellent: 好 /Good: 较好 /Fair: 差 /Poor: 不会 /None: 我的英语水平可以用英语学习 /I can be taught in English: 是 /Yes 否 /No c). 其他语言 /Other Languages: 5.

3 11. 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: 否 /No: 在华时间 /Time in China: 自 /From: 年 /Year 月 /Month 至 /To: 年 /Year 月 /Month 12. 申请人亲属情况 /Family Members of the Applicants: 姓名年龄职业 Name Age Employment 配偶 /Spouse: 父亲 /Father : 母亲 /Mother: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 所附材料情况 ( 请在所附附件前划 X 标明 )/Materials Attached (Please Indicate with X in the Bracket.): 申请表 ( 一式两份 )/ Application Form (in duplicate). 两封推荐信 /Two Letters of Recommendation. 有关中国院校接受函或录取通知书 /Admission Letter or Admission Notice of Chinese Universities. 本人最后学历成绩单复印件 ( 须公证, 一式两份 )/Transcripts of the Most Advanced Studies (Notarized Photocopy). 本人最后学历证书复印件 ( 须公证, 一式两份 )/Diploma of the Most Advanced Studies (Notarized Photocopy): 本科 /Bachelor s 硕士 /Master s 博士 /Doctor s 其它 /Others 外国人体格检查记录 ( 复印件 )/ Foreigner Physical Examination Form (Photocopy). 来华学习计划 / Study Plan in China. 所发表的文章等 / Articles or Papers Written or Published. 美术作品 ( 本人作品彩照六张 ) 音乐作品 ( 本人音乐作品盒式录音带一盘 )( 只限申请美术和音乐专业的申请人 )/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 ( 请列出 )/Other Attachments (List Needed): 注 : 每份申请材料最多不超过 20 页, 请全部使用 A4 纸 Each set of the complete materials should not exceed 20 pages. Please use DIN A4. 无论申请人是否被录取, 上述申请材料恕不退还 Whether the candidates are accepted or not, all the application materials will not be returned. 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 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 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. 来华后服从 CSC 所安排的就读院校和学习专业, 不得无故要求变更学校和所学专业 ; 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 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. 按照规定参加中国政府奖学金年度评审 ; I shall go through the procedures of the Annual Review of Chinese Government Scholarship Status as required. 6. 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 without valid reasons. 7. 如违反上述保证而受到中国法律法规或校纪校规的惩处, 我愿意接受中国国家留学基金管理委员会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 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. 申请人签字 /Signature of the Applicant: 日期 /Date: ( 无此签名, 申请无效 /The application is invalid without the applicant s signature)

申请人亲属情况 /Family Members of the Applicants: 姓名年龄职业 Name Age Employment 配偶 /Spouse: 父亲 /Father : 母亲 /Mother: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 所附材料情况 (

4 填表说明 ( 每一项数字与申请表中每一项序号相对应 ): GUIDELINES FOR FILLING IN THIS FORM (NUMBERS REFERRING TO THE VARIOUS BLOCKS): 1. 本项所有内容申请人必须如实填写 Personal information about the applicant must be filled in truly and correctly. 2. 请列出申请人已经完成或即将完成的各级教育, 包括中学职业教育及高等教育各项请随材料附上经公证的最高级教育的学历证明毕业证书或学位证书的原件复印件和英文翻译件 ( 均一式两份 ) Please provide the following information for all completed secondary, vocational, technical, undergraduate or post graduate training and qualifications. Any incomplete courses should also be listed. One notarized copy of your official transcripts certificates and notarized copies of English translations of your highest education must be included with each application form. 3. 请列出申请人曾经从事和现在从事的工作 Please clarify your work experiences and you current post. 4. 本项将表明申请人的语言情况, 对申请人来华后的课程安排及授课语言非常重要请随材料附上有关证明材料 Please state your knowledge of languages, especially Chinese and English. If you have passed a language test, please include a copy of the results in your application materials. This is very important because it will decide your teaching language in China. 5. 请申请人按本项提示选择来华后的学习计划,CSC 有权作相应调整 The applicant will choose the detailed information concerning his study in China according to the clues given in this cell. CSC is entitled to make any necessary adjustment according to the applicant s preferences. a. 请选择你申请来华学习的类别 Please choose what level of study you want to be engaged in in China. b. 请详细写出你申请来华学习的专业或从事研究的专题 Please specify your subject or field of study in China. c. 请从接受中国政府奖学金留学生的高等学校中选择三所并填写在本栏中, 你的选择仅作为 CSC 安排学校时的参考如果你已经被某所中国高校录取, 请附上该校的录取通知书或接受函的复印件 Please choose three preferences of Chinese institutions among the Chinese universities which can accepted Chinese Government Scholarship students and list them in the blanks here. The final arrangement of institution is subject to the adjustment of CSC with your choices as references. If you have been accepted by a Chinese university, please attach the copy of their admission notice to your application materials. d. 请标明你所申请的来华学习时间 Duration of the major study applied in China. e. 由于中国高校的主要授课语言为汉语, 所以来华后的汉语补习非常重要请在该项标明你是否需要汉语补习及所希望的汉语补习时间 Since the teaching language of Chinese universities is Chinese, it s very important for you to tell us in this cell whether you need elementary Chinese study prior to your major study or not. If Yes, please indicate the duration of the Chinese study (not included in the length of major study). 6. 请认真填写此项, 它对于学校确定申请人的学习专业及授课教师非常重要请说明你从事研究的题目或基本内容, 亦可以列出你希望的一些课程可另附纸 Please illustrate the subject of your research or the main content of your study, you can also give some courses you want to attend in China. It is crucial for the university to decide your major and arrange the professor for you. 7. 请列出申请人曾经发表的或曾写过的论文著作作品 Please list here your academic papers, writing and artwork published or written, if any. 8. 中国政府奖学金有全额奖学金和部分奖学金两种, 请选择你申请的一种 Choose the Scholarship you applied between the two offered by Chinese government full scholarship or partial scholarship. 9. 你的推荐人和推荐机构 The person or organization that recommend you for this scholarship. 10. 在华联系人或联系机构, 关于申请人在华的有关事务, 我们将与其联系 The guarantors charging your case in China, we will contact them for your case when necessary. 11. 如果你曾在中国学习或工作过, 请告知你在华的学习院校或工作单位 If you had ever been to China for study or work, please specify your institution, employer and time in China. 12. 申请人亲属的基本情况 General information about the applicant s family members.

请列出申请人已经完成或即将完成的各级教育, 包括中学职业教育及高等教育各项请随材料附上经公证的最高级教育的学历证明毕业证书或学位证书的原件复印件和英文翻译件 ( 均一式两份 ) Please provide the following

5 外国人体格检查表 FOREIGNER PHYSICAL EXAMINATION FORM 姓名性别男 Male 出生日期照片 Name Sex 女 Female Birthday ( 加盖检查单位印章 ) 现在通讯地址 Present mailing address Photo 国籍或地区 Nationality 出生地 Birth 血型 Blood type (Stamped Official Stamp) (or Area) place 过去是否患有下列疾病 :( 每项后面请回答否或是 ) Have you ever had any of the following diseases? (Each item must be answered Yes or No ) 班疹伤寒 Typhus fever No Yes 小儿麻痹症 Poliomyelitis No Yes 白喉 Diphtheria No Yes 猩红热 Scarlet fever No Yes 回归热 Relapsing fever No Yes 菌痢 Bacillary dysentery No Yes 布氏杆菌病 Brucellosis No Yes 病毒性肝炎 Viral hepatitis No Yes 产褥期链球 Puerperal streptococcus infection 菌感染 No Yes 伤寒和付伤寒 Typhoid and paratyphoid fever No Yes 流行性脑脊髓膜炎 Epidemic cerebrospinal meningitis No Yes 是否患有下列危及公共秩序和安全的病症 :( 每项后面请回答否或是 ) Do you have any of the following diseases or disorders endangering the public order and security? (Each item must be answered Yes or No ) 毒物瘾 Toxicomania No Yes 精神错乱 Mental confusion No Yes 精神病 Psychosis: 躁狂型 Manic paychosis No Yes 妄想型 Paranoid psychosis No Yes 幻觉型 Hallucinatory No Yes 身高厘米体重公斤血压毫米汞柱 Height CM Weight Kg Blood pressure mmhg 发育情况营养情况颈部 Development Nourishment Neck 视力左 L 矫正视力左 L 眼 Vision 右 R Corrected vision 右 R Eyes 辨色力 Colour sense 耳 Ears 心 Heart 皮肤 Skin 鼻 Nose 肺 Lungs 淋巴结 Lymph nodes 扁桃体 Tonsils 腹部 Abdomen

(Each item must be answered Yes or No ) 班疹伤寒 Typhus fever No Yes 小儿麻痹症 Poliomyelitis No Yes 白喉 Diphtheria No Yes 猩红热 Scarlet fever No Yes 回归热 Relapsing fever No Yes 菌痢 Bacillary

6 脊柱 Spine 四肢 Extremities 神经系统 Nervous system 其他所见 Other abnormal findings 胸部 X 线检查结果 ( 附检查报告单 ) Chest X-ray exam (attached chest X-ray report) 心电图 ECC 化验室检查 ( 包括艾滋病梅毒等血清学检查 ) Laboratory exam (attached test report of AIDS, Syphilis etc) 未发现患有下列检疫传染病和危害公共健康的疾病 : None of the following diseases of disorders found during the present examination. 霍乱 Cholera 性病 Venereal Disease 黄热病 Yellow fever 肺结核 Lung tuberculosis 鼠疫 Plague 艾滋病 AIDS 麻风 Leprosy 精神病 Psychosis 意见检查单位盖章 Suggestion Official Stamp 医师签字 Signature of physician 日期 Date

共健康的疾病 : None of the following diseases of disorders found during the present examination.

Microsoft Word - Scholarship Application.doc

Microsoft Word - Scholarship Application.doc 中国国家留学基金管理委员会 CHINA SCHOLARSHIP COUNCIL 中国北京复兴门内大街 160 号 100031 No.160 Fuxingmennei Street, Beijing 100031, P.R.China Tel: 0086-10-66413253 E-mail: laihua@csc.edu.cn Fax:0086-10-66413255