编号 : 孔子学院总部 Confucius Institute Headquarters No. 129, Deshengmenwai Street, Xicheng District Beijing P.R. China, 100088 http://www.hanban.org 孔子新汉学计划 Confucius China Studies Program(CCSP) 来华攻读博士学位项目申请表 Application Form for Ph.D. in China Fellowship 请用中 ( 英 ) 文填写此表格 Please complete the following form in Chinese or English. 1. 基本信息 Basic Information 姓 ( 以护照为准 ): Family Name (as appeared on passport): 出生日期 ( 年 / 月 / 日 ): Date of Birth (DD/MM/YY): 电话 : Tel: 当前联系地址 : Present Address: 名 ( 以护照为准 ): Given Name (as appeared on passport) 国籍 : 母语 : Nationality: Native Language: 电子邮件 : E-mail: 性别 :Gender: 男 Male 女 Female 学历 : Highest Degree: 永久联系地址 : Permanent Address: 2. 接受高等教育情况 Background in Higher Education 学校名称 Name of Institution 专业 Major 起止时间 Year of Attendance 所获学位 Diploma 1
3. 工作经历 Employment 机构 Employer 从事工作 Work Engaged 起止时间 Years of Service 4. 语言能力 Language Proficiency HSK 考试等级 / 孔子学院同等考试成绩 ( 如有请附成绩单 ): HSK Level/Confucius Institute Equivalent Test Score (Please attach transcripts): 汉语 Chinese 英语 English 听 Listening 说 Speaking 读 Reading 写 Writing 听 Listening 说 Speaking 读 Reading 写 Writing 5. 是否曾在华学习或工作?Have you ever studied or worked in China? 学习 : 是 否 起止时间 : Time (from/to): Study: Yes No 工作 : 是 否 起止时间 : Time (from/to): Work: Yes No 2
6. 硕士论文题目及主要研究成果及学术论文发表情况 Major Research Results and Academic Papers 硕士论文题目 : Dissertation Title of Master Degree: 主要研究成果及学术论文发表情况 : Major Research Results and Academic Papers: 7. 申请来华研究计划 Study Plan in China 课题名称 : Research Topics: 第一志愿 : First Choice : 第二志愿 : Second Choice: 中国大学名称 : Name of Chinese University: 中国大学名称 : Name of Chinese University: 导师姓名 : Full Name of Chinese Supervisor: 导师姓名 : Full Name of Chinese Supervisor: 研究计划 ( 须用中英文填写, 包括研究目的 内容 方法 成果等, 不多于 1000 字 ) Research Plan (Please fill in both Chinese and English, including objectives, contents, methods, results, etc. Please keep it within 1,000 words.) 3
8. 推荐人信息 Information of Referees 姓名 : Name: 1 联系方式 : Email: 职称 : Title: 2 姓名 : Name: 联系方式 : Email: 职称 : Title: 9. 推荐人的推荐信 ( 电子扫描件 ):2 Recommendation Letters (please attach 2 scanned letters) 4
10. 孔子学院推荐信 ( 电子扫描件 )Recommendation Letter from Confucius Institute (please attach scanned letter): 11. 大学本科 硕士学习期间成绩单, 学位证书原件 ( 电子扫描件 ) 及中文译本 : Copy of Notarized Academic Record of Undergraduate and Postgraduate Education, Degree Certificate and their Chinese Versions Respectively(please attach scanned files): 12. HSK 考试等级 / 孔子学院同等考试成绩 ( 如有请附成绩单 ): HSK Level/Confucius Institute Equivalent Test Score (Please attach transcripts): 申请人保证 : I Hereby Affirm That: 本表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; 我保证本人身体健康, 符合接收院校相关要求, 并于来华后提交有效的 外国人体格检查记录 原件 ; I affirm that I enjoy a good health that is consistent with the relevant requirements of the host institution. I shall submit valid Physical Examination Record For Foreigners after my arrival in China; 在华期间, 遵守中国法律 法规, 不从事任何危害社会秩序的 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 in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student; 按规定期限离华, 不无故在华滞留 ; I shall leave China according to schedule, and will not extend my stay without valid reasons; 在华期间, 奖学金之外所产生费用与孔子学院总部及在华就读院校无关 ; During my stay in China, expenses incurred apart from scholarships will be irrelevant to Confucius Institute Headquarters and the host institution; 如违反上述保证而受到中国法律 法规或校纪 校规的惩处, 我愿意接受孔子学院总部中止或取消奖学金及其他相应处罚 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 Confucius Institute Headquarters on suspending, or withdrawing my scholarship, of other penalties. 申请人签字 : 日期 : Signature of the Applicant: Date: 5