2011032909552993.doc-chongqingmedicaluniversity.docVIP

No. 学生类别 学习专业 重庆市教育委员会 CHONGQING MUNICIPAL EDUCATION COMMISSION 中国重庆市江北区董家溪鹅石堡山26号 邮编：400020 Add: No.26 Eshibaoshan, Dongjiaxi, Jiangbei District, Chongqing，P.R. China 400020 电话 Tel：0086-23-座机电话号码; 传真 Fax：0086-23-座机电话号码 学校填写The above table is only for Http//: Chinese higher education institutions 重庆市人民政府外国留学生市长奖学金申请表 APPLICATION FORM FOR CHONGQING MUNICIPAL GOVERNMENT MAYOR SCHOLARSHIP 请用中文或英文填写此表格。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。不按规定填写的表格将视作无效。 Please read carefully the important notes on the last page before filling out the form. 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. Any forms that do not follow the notes will be invalid. 照片 2 inches Photo 1. 申请人情况/Personal Information 护照用名/Passport Name 姓/Family Name 名/Given Name 国籍/ Nationality 护照号码/ Passport No. 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 男/Male □ 女/Female □ 已婚/Married □ 未婚/Single □ 其它/Other □ 母语/Native Language 宗教/Religion 当前联系地址/ Present Address 电话/Tel 传真/Fax E-mail 永久通信地址/Permanent Address 2. 受教育情况/Education Background 学校 在校时间 主修专业 毕业证书及学位证书 Institution Years Attended from/to Fields of Study Certificates Obtained or To Obtain 3. 工作经历/Employment Record 工作单位 起止时间 从事工作 职务及职称 Employer Time from/to Work Engaged Posts Held 4. 语言能力/Language Proficiency a 汉语/Chinese: 很好/Excellent □ 好/Good □ 较好/Fair □ 差/Poor □ 不会/None □ HKS考试等级或其他类型汉语考试成绩/Level of HKS test or other certificates which can show your Chinese level: b 英语/English: 很好/Excellent □ 好/Good □ 较好/Fair □ 差/Poor □ 不会/None □ 我的英语水平可以用英语学习/I can be taught in English: 是/Yes □ 否 /No □ c 其他语言/Other Languages: 5. 来华学习计划（第一类对象填写）/Proposed Study in China Only for the first kind of applicants a 本科生/Bachelor’s 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: □