广西政府东盟国家留学生奖学金申请表

广西政府东盟国家留学生奖学金申请表 附件3 广西政府东盟国家留学生奖学金申请表 (全额奖学金) GUANGXI GOVERNMENT FULL SCHOLARSHIP APPLICATION FORM FOR ASEAN STUDENTS 请申请人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。不按填写的表格将视作无效。 Please complete the form in Chinese or English. ,,,, ,, the form with computer, or 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. 照片 Photo 1. 申请人情况/Personal Information: 护照用名/Passport Name:__________________________ 姓/Family Name: _________________________________ 名/Given Name: ________________________________ 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: ____________________________ E-mail: ______________________________________ 永久地址/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/ Major of Study _______________________________________________________________________________ 毕业证书及学位证书/ Diploma or Degree Obtained or To Obtain _____________________________________ ______________________________________ _____________________________________ ______________________________________ 3. 工作经历/Employment Record: 1 工作单位/ Employer _______________________________________________________________________________ 起止时间/ Time (from—to) _______________________________________________________________________________ 从事工作/ Work Engaged _______________________________________________________________________________ 职务及职称/ Posts and Titles Held _______________________________________________________________________________ 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/ Level of HSK test _________________________________________________ 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. 来我校学习/Proposed Study at Our University a) 研究学者/Research Scholar ? 汉语进修生/Chinese Language Student ? 本科生/Bachelor’s ? 硕士生/Master’s ? 博士/Doctor’s ? 其它/Others ? b) 申请来我校学习的专业或研究专题/ Program or Field of Study at our University ____________________________________ ____________________________________ c) 申请学习时间/Duration of Study: 自/From:年/Year______ 月/Month______ 至/To:年/Year______ 月/Month _______ 6. 拟在我校学习或研究的内容(可另附纸)/ Please Describe the Details of your Study or Research Plan at our University (an extra paper can be attached if this space is not enough): _______________________________________________________________________________ _______________________________________________________________________________ 2 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: 全额奖学金/Full Scholarship ? 推荐您申请我校奖学金的机构或个人/Please Specify the Organization or Person Recommending you for this Scholarship: _______________________________________________________________________________ 9. 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:__________________________ 10. 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: _______________________________ 在华时间/Time in China: 自/From: 年/Year_____ 月/Month_____ 至/To: 年/Year_____ 月/Month _____ 否/No:? 11. 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: ________________________ ______________ _________________ 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. 来华后服从学校安排，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 Guangxi made by the University, and will not apply for any changes 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 by the rules and regulations of the host university, and 3 concentrate on my studies and researches, and follow the teaching programs arranged by the university. 5. 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. 6. 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 withdrawing my scholarship, or other penalties. 申请人签字/Signature of the Applicant:____________________________ 日期/Date:____________________ 接收学校领导签字:____________________ 接收学校公章: 4