学历留学生（本科）入学申请表

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1 学历留学生 ( 本科 ) 入学申请表 Application Form for International Students (Undergraduate Degree Program) 注意 : 请申请人用中文或英文清楚地填写以下诸项不能缺项填写, 没有的请写无 Please complete all the information requested. Please write None if not applicable. 护照名 ( 英语 ) 姓 F a m i l y N a m e : Full Name with Middle Initial 中间名 M i d d l e N a m e : 照片 in English according your passport 中文名名 G i v e n N a m e : PHOTO Chinese Name 国籍 Country of citizenship 性别 Gender 男 Male 女 Female 出生日期 Date of birth 护照号码 Passport No. 宗教信仰年 /yy 月 /mm 日 /dd 出生地点 Place of birth 护照有效期 Valid until 婚姻状况国家 Country 城市 City 年 /yy 月 /mm 日 /dd Religion Marital Status 申请专业 Major of Applying Please Tick MBBS (Bachelor Degree of Clinical Medicine and Surgery) BDS (Bachelor Degree of Dentistry and Surgery)

2 职业学习或工作单位 Occupation 电话手机 Institution/Employer 电子邮件 Tel & Cell phone 本国住址 Home Country Address 邮政编码 Zip Code 电话 / 传真 Tel/Fa x 录取通知书邮寄地址 Mailing address for the 如地址有变, 请及时告知 Please inform the International Students Office for any change of this address. Admission package 收件人邮政编码电话 / 传真 Receiver Zip Code Tel/Fax 学习经历 ( 从小学开始填写 ) Educational background(from Elementary School) 学校名称在校时间主修专业 & 所获证书证书编号优点或特长 Institutions Years attended (from/to) Field of study & Diploma received No. of Diploma Specialities 工作经历 Employment Record

3 工作单位起止时间从事工作职务 Employer Years attended (from/to) Occupation Position 语言能力, 请用好, 一般, 不会评价 Language proficiency(good/average/none) 汉语 Chinese HSK: 级 ; 新 HSK ( 初级中级高级 ):,, ; BCT: 英语 English TOEFL(score) ; GMAT ; GRE ; IELTS 其他 Other 推荐单位 Recommended by 推荐单位联系人 Recommended by 联系地址 Contact person 电话 / 传真 Address Tel/Fax 经费来源 Financial Support 保证人姓名 Guarantor s name: 自费 Selfsupport 与申请人关系 Relationship with the applicant: 地址 Address: 电话 / 传真 Tel/fax: 保证人签名 Guarantor s signature :

4 奖学金名称 Scholarship name: 奖学金提供奖学金单位 Provided by: 联系人 Contact person : Scholarship 电话 / 传真 Tel/Fax: 家庭情况 Family Status 称谓姓名职业联系电话电子邮件 Appellati on Name Occupation Tel 您的家庭年收入是多少美元? Annual family income (USD) 在华事务联系人 Contact person in China 姓名电话手机电子邮件 Name 工作单位 Tel & Cell phone Employer 联系地址 Address 是否从中国大陆香港澳门和台湾移民否 No Are you an emmigrant from mainland of China,Hongkong,Macau or Taiwan?

5 1 何时取得外国国籍?In what exact date did you get the overseas citizenship? 是 Yes 2 实际在国外居住多久?How long have you been actually living abroad? 申请人保证 /I hereby affirm that: 报名时请提供相关的记录 Please provide the relevant records when you apply to. 1) 上述各项中填写的信息和提供的材料真实无误如因个人信息错误失真造成不良后果, 责任由本人承担 All information and materials provided are factually true and correct. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I ve certified be false. 2) 在华期间, 遵守中国的法律和法规, 不从事任何危害中国社会秩序的, 与本人来华学习身份不相符合的活动 ; During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate in any activities which are deemed to be adverse to the social order in China and are inappropriate to the capacity as a student; 3) 在学期间, 遵守学校的校纪校规, 尊重学校的教学安排 During my study in China, I shall observe the rules and regulations of the university, and will concentrate on my studies and researches, and will follow the teaching programs provided by the university. 申请人签字 (Applicant s Signature): 日期 Date: ( 无此签名, 申请无效 The application is invalid without the signature.)

6 申请人在提交本表时, 请同时提交 Applicant should also submit the followings documents. (1) 高中以上毕业证书 (1)Diploma and degree (2) 成绩单 (2)Related transcripts (3) 英语水平证书 (3)English Level Certificate (4) 护照复印件 (4)Valid passport copy 无论申请人是否被录取, 上述申请材料恕不退还 Whether the candidate is accepted or not, all the application material will not be returned

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