ICSCC, Fudan University.doc

ICSCC, Fudan University 2013 Summer Program in Buddhism and Chinese Religions Application Form申請表 1. Applicant’s Personal Information個人信息表 Family Name姓 First Name名 Mailing Address通信地址 City市 State/Province省 Country國家 Postal Code/Zip郵編 Telephone電話號碼 Fax傳真 Email電郵 Date of Birth (dd/mm/yyyy) 生日（日/月/年） Gender性別 Nationality國籍 Passport/ID Card Number 護照號碼/身份證號碼 Status in China/Visa Number 在華簽証種類 Native Language 母語 Special needs 特殊需求 I am a vegetarian素食者. yes I am allergic to ( ). 　對（ ）過敏 2. Institution at which you are currently working? 學習/工作單位 University/Institution 大學/研究所 Department/Institute系/所 Mailing Address通信地址 City市 State/Province省 Country國家 Postal Code/Zip郵編 Telephone電話號碼 Email電郵 3. Alternate Contact (the contact information of your parents or friends) 緊急聯繫信息（父母或朋友的練習信息） Contact name聯系人姓名 Mailing Address通信地址 City市 State/Province省 Country國家 Postal Code/Zip郵編 Telephone電話號碼 Email電郵 4. Knowledge of languages語言能力Assess your proficiency in reading, writing, listening and speaking in the following languages請評斷對以下語言在聽、說、讀、寫四個方面的能力:　 1-excellent非常好, 2-good好, 3-sufficient充分, 4-insufficient不足 Reading讀 Writing寫 Listening聽 Speaking說 English英語 Chinese漢語 others其他 5. Academic profile and research project學術研究情況 Field of research研究領域 Topic of your previous project (B.A., or M.A., etc) 先前研究課題（碩士或本科階段） Topic of your current project (M.A., or Ph.D., etc) 目前研究課題（碩士或博士等） Highest academic degree 最高學位 . How did you find out about our summer program? (multiple answers) 通過何種途徑獲知我們的暑期佛學研修班(多項選擇) a. through internet search通過網絡搜索 b. from the Website of “UBC-TCU-RUC Summer Program” 通過暑期佛學研修班的網站 c. from a teacher 通過老師 d. from a friend 通過朋友 e. through other venues其他途徑 (please specify此途徑為: ) 7. Declaration of consent協議聲明 I hereby declare that the above statements are correct and that I am of sound health?for carr