长春市前进大街2699号※

长春市前进大街2699号※ 学号: 专业: JILIN UNIVERSITY, CHINA 学院: Office of International Students 中国 长春市前进大街2699号 130012 请勿填写此处(Do not write in this space) 2699 Qianjin Street, Changchun 130012, Friendship Guest House P. R. China Tel: 86-431-85166885 Fax: 86-431-85166570 E-mail: liuxue@jlu.edu.cn 吉林大学外国留学生入学申请表 APPLICATION FORM FOR INTERNATIONAL SCHOLARS , STUDENTS 请用中文或英文填写。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。 Please complete the form in Chinese or English. If the form is not filled in on PC，please write legibly in black or blue ink. Please indicate with ‘X’ in the blank chosen. 1.申请人情况/Personal Information: 护照用名/Passport Name: 照 片 英文姓名/Name in English: (Photo) First name Middle name Last name 中文姓名/Name in Chinese: 国籍/Nationality: 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: 护照号码/Passport No.: 有效期至/Valid Until:年/Year: 月/Month: 男/Male:? 女/Female:? 已婚/Married:? 未婚/Single:? 其它/Other:? 母语/Native Language: 宗教/Religion: 职业或身份/Occupation or Status: 工作或学习单位/Employer or Institution Affiliated: 录取通知书邮寄地址/Mailing Address : 邮编/Zip code: 家庭地址/Home Address: 家庭电话/Home Tel: 传真/Fax: 2.语言能力/Language Proficiency: a) 汉语/Chinese: 好/Good:? 一般/Average:? 不会/None:? HSK 考试等级/ Level of HSK Test: b) 英语/English: 好/Good:? 一般/ Average:? 不会/None:? c) 其他语言/Other Languages: 好/Good:? 一般/ Average:? 不会/None:? 3.来华学习/Proposed Study in China: a) 本科生/Baccalaureate Degree Candidate: ? 汉语进修生/Chinese Language Student: ? 硕士研究生/Master’s Degree Candidate: ? 普通进修生/General Scholar: ? 博士研究生/Doctoral Degree Candidate: ? 高级进修生/Senior Scholar: ? b) 来华申请学习的专业或研究专题/Subject or Field of Study in China: c) 申请学习时间/Duration of the specialized Study: 自/From:年/Year 月/Month 至/To:年Year 月/Month 4.经费来源/Financial Support: 自费/Self-supporting ? 校际交流/Institutional Exchange ? 经费资助/Organization Sponsored ? 资助单位名称/Name of the Organization: 5.申请人在华事务担保人及单位/The Guarantor Charging Your Case in China: Name: 电话/Tel: 传真/Fax: 姓名/ 单位名称/Organization: 地址/Address: 6.推荐单位情况/Background Information of Recommending Organization: 单位名称/Organization: 电话/Tel: 传真/Fax: 地址/Address: 7.申请人直系亲属姓名/Name of Family Members: 父亲/Father: 母亲/Mother: 配偶/Spouse: 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、法规和吉林大学的校纪、校规; During my stay in China, I shall abide by the laws and decrees of the Chinese government，the rules and regulations of Jilin University. 3.在学期间，申请人在遇到意外事故需要采取急救治疗时，同意授权吉林大学留学生办公室管理人员代表其家属 在手术通知单上签字。 During my study in Jilin University, I agree that the administrative staff, on behalf of my family dependant, has the authority to sign on the Notice of Operation, when I need emergency treatment for contingency. 申请人签字/Signature of the Applicant: 日期/Date: