西安市“中亚五国”留学生教育培训计划项目专项奖学金申请表Application Form for the "Five Central Asian Countries" International Student Education and Training Program scholarship in Xi'an

护照用名

/Name in 

passport

姓/Family name

中文名

/Chinese name:

照片

Photograph

名/Given name

国籍

/Nationality

护照号码

/Passport No.

出生日期

/Date of birth

年月日

/year /month /date

□男/Male  

□女/Female

 □已婚/Married

□未婚/Single

出生地点

/Place of birth

 宗教

/Religion

最后学历/ Highest academic qualification

职业或身份/Occupation

工作或学习单位/Study or work place

母语/Native language

永久通讯地址/Address:

电话/Tel:                     传真/Fax:                    E-mail:

汉语/英语水平/ Chinese/English language proficiency

Chinese:   None   HSK Level ___     others___

English:   None   IELTS___   TOEFL___ others___

申请学习类别/Applying Program:

1. 层次/Program type: 

□本科/Bachelor               □专科/Junior College 

2. 专业/Major: ______________________________________________ 

3. 学习时间/Study duration从/from    年/Y   月/M   日/D  到/to   年/Y   月/M   日/D

4. 奖学金种类/Scholarship type:  

□一类/Type A                  □二类/ Type B 

家庭主要成员/Family members 

姓名/ Name关系/Relation  电话和传真/ Tel. & Fax   工作单位/Workplace职位/ Post

本人简历(从高中开始)/Curriculum vitae（Starting from senior middleschool）

年/Y 月/M 到/to 年/Y 月/M        Institution      Position

eg：2012.06—2014.06            xx middle school   student

我愿意到西安学习，在校学习期间保证做到下列各项：

1. 遵守中华人民共和国法律。

2. 遵守学校的各项规章制度，努力学习。

3. 按时缴纳学校规定的学生应该缴纳的各项费用。

4. 上述各项中填写的内容是真实无误的。

I am willing to study in Xi’an, and pledge the following terms during my study:

1. I will abide by the laws of the People’s Republic of China.

2. I will abide by the rules and regulations of the school and study hard.

3. I will pay all expenses on time.

4. All the information in this form is true and correct.

学生本人签字/Applicants signature:

日期/Date: