Application Form for Doctoral Degree Candidate s Name Student Number School/Department Discipline/Professional Degree Major/Field Supervisor Vice Supervisor 2016 Graduate School of Tongji University (2016) / / (mm/dd/yy)
Instructions Fill in the form carefully. Additional pages allowed. Fill in the form in blue or black ink, or print it out after filling. Discipline : This space is for a doctoral candidate applying for an academic degree. And the disciplines here include: Philosophy, Economics, Law, Education, Literature, Natural Science, Engineering, Medicine, Management Science and Art. Professional Degree : This space is for a candidate applying for a doctoral degree in Clinical Medicine, in Stomatological Medicine, and in Engineering. Major : Doctoral candidates applying for academic degrees fill in this space in accordance with the majors (first-class subjects) or minors (second-class subjects) stipulated in your Training Program. Field : Refers to minors (second-class subjects) for doctorial candidates of Doctor of Clinical Medicine. This clause is for the Academic Degree Evaluation Sub-committee. The department is responsible for archiving.
Personal Information Chinese Name English Name n/a n/a Passport No. / Gender n/a / Date of Birth n/a n/a / / / / / / / / / / / / / / / / / / Nationality / / (mm/dd/yy) / Photo / 45 * 35mm Notes: ID photo, color; Size:45X35mm [ ] [ ] [ ] [ ] [ ] Degree Public Prequalification Masters-PhD Bachelors-PhD Bachelors-PhD Progressions Examination Advancement Progression Progression Progression (continued program) Admission date Beginning and Ending Dates Learning schedule [ ] [ ] [ ] Full-time Half-time Part time School/Business Position Education and work experiences (Beginning with high school) Awards in school Undergraduate information with major in Postgraduate information with major in / On / / (Date), the candidate graduated from, and Bachelor Degree/certificate of On / / (Date), the candidate graduated from, and Master Degree/certificate of 1
Academic Records Paste Here (Paste Line) 2
Scientific Research Achievements During the Study Period 5 Publications (fill up to 5, the unit is Tongji University signed, first author, or mentor first I second) 1 SCI EI CSSCI SSCI Number Date of Titles of Publications Publishing Publisher ISSN ISBN Author s Name Accession Number / ISSN / ISBN 2 3 4 5 Awards or Patents 2 Awards and Patents ( fill up to 5 ) Date Awarding organization Level Ranking Certificate No. 1 2 1. SCISSCIEICSSCI 2. ISSN 1000-4203 3. ISBN 7-302-03778-7 4. ZL I promise: Information filled is true and correct. If it is not real, I m willing to bear the responsibility and consequences. Signature / / (mm/dd/yy) 3
Summary of the Study Period 500 Professional knowledge, research work, practical skills, problem-solving abilities (within 500 words): Signature of Candidate: / / (mm/dd/yy) 4
Supervisor s Comments Supervisor s comments on the candidate s mastery of theories, research capability, foreign language proficiency and learning attitude; Supervisor s comments on the candidate s degree paper, and opinion on whether the candidate can be approved to present the dissertation defense. 5
Signature of Supervisor: / / (mm/dd/yy) 6
Dissertation Review and Defense Review Period Review Comments Dissertation Title Summary Total / / - Number of / / Copies for Reviewers Number of Copies for Anonymous Reviewers Number of Returned Copies Approvals: Disapprovals: Approvals (Anonymous reviewers): Planning Date of Dissertation / / Defense Name Title Organization Dissertation Reviewers Chairman Defense Committee Members Secretary / Discipline Committee's Comments: Signature of Director: / / (mm/dd/yy) The Academic Degree Evaluation Sub-Committee Comments: Signature of Chairman of the Academic / / (mm/dd/yy) Degree Evaluation Sub-Committee: 7
Conclusion of the Defense Committee Conclusion: The number of defense committee members is, and the number of members voting to grant the doctorate is. In accordance with Degree-Conferment Instruction of Tongji University: Signature of Chairman of Defense Committee: / / (mm/dd/yy) Notes: In accordance with Article 17 of Degree-Conferment Instruction of Tongji University: 1. If More than, or exactly, 2/3 of all the defense committee members vote to grant the degree, choose propose granting the candidate a doctorate. 2. If More than, or exactly, 1/2 and less than 2/3 vote to grant the degree, choose The candidate may, within two years, revise their papers and apply for defense again. 3. If less than 1/2 vote to grant the degree, choose propose not granting the candidate a doctorate. 8
Decision of the Academic Degree Evaluation Sub-Committee [] Academic Degree Evaluation Sub-Committee has members, meeting on (Date). The number of members attending the meeting is. After voting, members agree granting the candidate a doctorate. In accordance with Degree-Conferment Instruction of Tongji University Agree granting a doctorate of Signature of Chairman of the Academic Degree Evaluation Sub-committee: 9
Record of Academic Degree Evaluation Committee of Tongji University (Paste Line) 10