北京市政府奖学金申请表-CUCAS.doc

PAGE  PAGE 4 北京开放大学外国留学生奖学金申请表 SCHOLARSHIP APPLICATION FORM FOR FOREIGN STUDENTS BY BEIJING OPEN UNIVERSITY 请申请人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‘×’表示。不按规定填写的表格将视作无效。 照片 PhotoPlease complete the form in Chinese or English. If you could not complete the form on PC, please write legibly in black or blue ink. Please indicate with ‘×’ in the blank chosen. Any forms that do not follow the notes will be invalid. 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/ Institutions _______________________________________________________________________________ 在校时间/ Years Attended (from—to) _______________________________________________________________________________ 主修专业/ Fields of Study _______________________________________________________________________________ 毕业证书及学位证书/ Certificates Obtained or To Obtain _____________________________________ ______________________________________ 3.工作经历/Employment Record: 工作单位/ Employer _______________________________________________________________________________ 起止时间/ Time (from—to) _______________________________________________________________________________ 从事工作/ Work Engaged ___