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Page 1 of 3 WORLD AMERICAN CULTURAL EXCHANGES The 2+2 Sino-American Dual Degree Program Application2+2中美双学位计划申请表 Please attach one pre-cut, smiling photo of yourself, approximately this size here 请将您面带微笑的照片贴在此栏 Personal Information个人信息: Family Name姓_________________Given Name名_________________________ ○ Male男 ○ Female 女 Birthdate出生年月日 ____/____/____ BirthCity出生城市______________________ Passport #护照号码________________Issued City 签发城市_______________________ Issued Date签发日期_____/_____/____Expires Date有效期 _______/_____/____ ID#身份证号_____________________________________ WACE Official Use Only 审查批注用 Permanent Address永久地址 ____________________________________________________________________________________________________________ Address as it should appear on correspondence if it is not the same as above与以上不同的邮寄地址 ___________________________________________________________________________________________________________ (Street街道号码) (City城市) (Postal Code邮编) (Providence or State省) Home Telephone家庭电话___________________ Cell Phone本人手机__________________ Email电子邮箱: __________________ Father, Family Name父亲姓___________Given Name名_____________ DOB出生年月日_______Occupation职业________________ Employer Name Address工作单位名称地址_________________________________________________________________________ (Street街道号码) (City城市) (Postal Code邮编) (Province or State省) Business Telephone单位电话__________________ Cell Phone手机_________________ Email电子邮箱: ______________________ Mother, Family Name母亲姓__________ Given Name名______________ DOB出生年月日_______Occupation职业______________ Employer Name Address工作单位名称地址_____________________