中山大学与美国休斯顿大学（3+1）本科生联合培养项目申请表.doc

中山大学与美国休斯顿大学（3+1）本科生联合培养项目申请表 Application for Admission as a Student of “3+1” Program Between Sun Yat-Sen University and Houston University 个人信息Personal Information 姓名Name 性别Gender 近照 Recent Photo 年级专业 Grade and Major 学号 School Number 身份证ID No. 出生日期Date of Birth 电话Phone No. 手机Mobile 邮箱地址 E-mail Address 通讯地址 Correspondence Address 语言水平Language Proficiency 托福成绩 TOEFL 其他英语水平 Other English Level 教育信息Academic Information 年级Current Year of Study 专业Major of Study 成绩绩点 Credit 年级（班）排名 Rank in grade(class) 奖励与荣誉Honors and Awards 学术成果Academic Achievements 申请人声明Declaration 我声明本申请表格内的相关信息及其证明文件都是准确无误的。 I declare that the information given above and the documents in support of this application are accurate and complete. 申请人签名 Signature of Applicant 日期 Date 推荐人/咨询人Consultant 姓名 Name 学衔 Academic Title 电话 Phone No. E-mail 中山大学化学与化工学院意见Supporting Statement from School of Chemical Chemical Engineering，Sun Yat-Sen University (签名) Signature 日期（Date） 休斯顿大学相关院（系）意见Supporting Statement from Houston University (签名) Signature 日期（Date） 备注：该申请表应连同一份教务处英文成绩单、个人简历、托福成绩单、两封专家推荐信、护照复印件及相关证明材料一起交到学院办公室林莉莉老师处。 Notes: This application should be submitted to the Office of Chemical Chemical Engineering, together with an sealed official academic transcript and two recommendation letters, one copy of Passport, relevant materials. 2