辽宁省大连市甘井子区轻工苑1号

辽宁省大连市甘井子区轻工苑1号 中国 辽宁省大连市甘井子区轻工苑1号 大连工业大学 国际交流与合作处 116034 International Cooperation & Exchange Department, Dalian Polytechnic University No.1 Qing Gongyuan, Gan Jingzi District, Dalian City, Liaoning Province,116034, P.R.China. 电话&传真(Tel.& Fax):86-411-86324486 86-411-86323647 电子邮件(E-mail): iced@dlpu.edu.cn 网址(Website): 外国留学生入学申请 APPLICATION FORM FOR INTERNATIONAL STUDENTS TO STUDY IN DPU 请用正楷填写/Please write clear in BLOCK LETTER 姓 (Family name): 外 文 In English 姓 名 名 (Given name): 照 片 Name 中 文 性别 ?男(M) Photo In Chinese Sex ?女(F) 国 籍 婚 否 ?是yes Nationality Marital Status ?否no 出生日期 年 月 日 出生地点 Date of Birth Year month day Place of Birth 护照号码及有效期 宗教信仰 Passport No./Valid Until Religion 本人学历 职 业 Educational Background Occupation 学习或工作单位 Employer or School Affiliated 永久通讯地址 Permanent Address 电话及传真 Tel: 电子信箱 Tel&Fax. No. Fax: E-mail 是否预定学校宿舍, 是 ? 否 ? Do you want to reserve room or bed on campus? Yes No 单人间 ? 标准双人间 ? 留学生公寓 Single Bed Standard Double Beds Foreign Student Dorm 普通双人间 ? 普通四人间 ? Double Beds Four Beds 如没有所选定的房型～是否愿意服从学校安排, 是 ? 否 ? Are you willing to be arranged to other kind of room by Yes No University, if the room you apply for is not available? 汉语水平,用优、良、一般、不会评估, ?优E ?良G ?一般P ?不会N 读(Reading): Present Level of Chinese 听(Listening ):?优E ?良G ?一般P ?不会N 说(Speaking):?优?良?一般 ?不会 E G PN(Excellent,Good ,Passable,None) 已学习汉语时间及地点 No. of hours Chinese studied&where 现有的HSK级别 会何种其他语言 Level of HSK Proficiency in Foreign Languages 预计留学期间 自 年 月 日 到 年 月 日 Duration of Study at DPU From Yr. Mo. Da. To Yr. Mo. Da. 经济资助 ? 自费 ? 政府资助 ? 其它 Financial Support Personal Fund By Government Others 担保人 Your guarantor in case of emergency during your stay at DPU 姓名/Name: 单位/Name of your employer: 国籍/Nationality: 与本人关系/Relationship to the applicant: 电话/Tel: 传真/Fax: 永久地址/Permanent Address: 推荐单位及电话 Reference &Tel. 申请人保证/I hereby affirm that: 1) 上述各项中所提供的情况是真实无误的, All the information given in this form is true and correct, 2) 在中国学习期间遵守中国政府的法律和学校的规章制度, I shall abide by the laws of the Chinese Government and the regulations of the school, 3) 不从事学习目的以外的活动～按时缴纳学校规定的学生应该交纳的各项费用。 I will not engage in activities bearing no relation with my academic pursuit in China. I will pay all expenses on time. 日期 年 月 日 申请人签名: Date Yr. Mo. Da. Signature of the Applicant: 特别提示/Special Hint: 1)本表可复印使用,The photocopied version of this form is valid. 2)为保证留学生的学习和健康～我们建议留学生在来华前办好医疗及意外伤亡保险,也可到校后在中国办理相应保险。未参与上述保险者～后果自理。 In order to protect the foreign students’ well-being in their studies and health. We strongly advice foreign students to sign up for medical and accident insurance policy. They can do so either in their own country or in China. Students without an insurance policy mentioned above will have to bear the consequences themselves if the need for medication arises in the case of accidents and illnesses. 注:如您申请学位、专业，请继续填写外国留学生申请表(二) Please complete form (?) if you are applying for degree program 外国留学生申请表(二) Application Form ( II ) for Foreigners to Study at DPU 请用正楷填写/Please write clear in BLOCK LETTER 请按时间先后顺序填写本人中/高等教育学历: List in chronological order your secondary/higher education. 学校 在校时间,自…/至…, 所获证书、学位 主修专业 Institution Years attended (from/to) Diploma received Field of study ________________ _____________________ ________________ _____________ ________________ _____________________ ________________ _____________ ________________ _____________________ ________________ _____________ ________________ _____________________ ________________ _____________ 工作简历/Present occupation and previous employments. 时间 工作单位 职务/职称 Date Employer Position or Title _____________ ___________________________________ _____________________ _____________ ___________________________________ _____________________ _____________ ___________________________________ _____________________ _____________ ___________________________________ _____________________ 来华留学类别,请在方框内画“?”, Indicate the nature of the program you wish to undertake in China (please tick) ?本科生 ?硕士研究生 ?博士研究生 ?进修生 Bachelor’s Degree Master’s Degree Doctor’s Degree Advanced student 来校学习/研究 Describe the plan of study / research you wish to undertake in Dalian Polytechnic University 1) 学习/研究专业: Field of study or research a. b. c. 2) 学习/研究期限 Duration of study or research __________ _______________________________________ 对学习研究专业的补充说明,如本栏篇幅不够～可附另页,: Any other information you consider relevant to this plan (Use a separate page if necessary). 注:,1,请务必交验中文或英文的学历证书和成绩单复印件 Note: (1) Copies of diploma and transcripts in Chinese or English must be submitted. Documents not in Chinese or English must be accompanied by certified translations. (2)如果申请攻读研究生～请附上由指导过你的正/副教授出具的两封推荐信～并列出他们的 姓名、职务职称和地址。 (2) If you want to apply for a GRADUATE PROGRAM, please submit two supporting letters written by associate professors or professors under whom you have studied. Please list their names, positions/tittles and addresses. 姓 名 职务/职称 地 址 Name Position/Title Address ________________ _____________________ _____________________________ ________________ _____________________ _____________________________ 日期 年 月 日 申请人签名_______________ Date Yr. Mo. Da. Signature of the Applicant 注 意: 所填内容必须正确无误～不完整的申请表或未按要求交验有关材料～将会延 误对此申请的审理时间。 Important: All the information should be true and correct. An incomplete application, or the supporting document not submitted, WILL DELAY the process of your application.