北京大学外国留学生新生奖学金申请表.doc

北京大学外国留学生新生奖学金申请表 Application Form for Peking University Freshmen Scholarship 申请人基本情况/Personal Information 护照用名 Passport Name 中文姓名 Chinese Name 性别 Gender 国籍 Nationality 护照号码 Passport No. 出生日期 Date of Birth 联系电话 Tel 电子邮件 Email 本科/硕士/博士 被录取的院系/Department/School 被录取的专业/Major 博士生导师姓名 Name of Supervisor (Doctoral Program Only) 在校学习期间志愿参加的活动/Groups Volunteered to Join in at PKU 在校学习期间志愿参加的活动（可多选） Preferred Group (Multiple Choice): □助管Counselor Assistant □志愿者Volunteer □无None □留学生艺术团 Arts Group （○艺术特长： __________________________； ○体育特长：_______________________________） 未获得其他任何形式奖学金资助声明/Statement of Not Receiving Any Scholarship 我在此声明并保证：我在申请北京大学外国留学生新生奖学金前未获得其他任何形式的奖学金资助，并且保证在获得该奖学金资助后在北京大学学习期间将不再申请其他任何形式的奖学金。I hereby affirm that I have not received any scholarship before I apply for the Peking University Freshmen Scholarship and that during my study at Peking University I shall not apply for any other scholarship if I get the Peking University Freshmen Scholarship. （如同意，请重新抄写一遍以上内容/ If you agree, please re-write the above information） 申请人保证/ I Hereby Affirm that: 上述各项中所提供的情况是真实无误的； All the information I provided above is true and correct; 在校学习期间，遵守中国政府的法规，北京大学的校纪校规和奖学金的有关章程； I shall abide by the laws and decrees of the Chinese Government, the rules of Peking University and the regulations of the scholarship; 若获得奖学金资助，将按照规定接受奖学金年度考评。 Once approved, I shall take part in the annual review and evaluation of the scholarship. 申请人签字：_________________________ 日期：________________ Applicant’s Signature: Date: