中国武术段位制海外人员申报表.docVIP

中国武术段位制海外人员申报表 （1-9段） Application Form of Chinese Wushu Duan Wei System For Overseas Practitioners (1- 9Duan) 相 片 Photo 姓名 Name 性别 Sex 出生年月 Date of Birth 国家 Nationality 申报段位 Applied Duan 原段位 Original Duan 申报项目 Applied Event 习武年限 Duration of Wushu Practice 职业 Profession 文化程度 Education Level 职称及获得时间 Professional Title and Date of Obtaining It 通信地址 Postal Address 电话/传真 Tel/Fax No. 习武经历 (可加附页) Experience of Wushu Practice (Attached Paper Can Be Added) 老师鉴定 Teacher’Appraisal 老师签字： Teacher’s Signature: 老师段位 Teacher’s Duan: 考评成绩 Results of the Examination 技术考评成绩 Technical Results 理论考评成绩 Theoretical Results 考评组长签字： Signature of the Group Leader of the Examination: 考评委员会意见 Viewpoints of the Examination and Appraisal Committee 考评委员会主任签字： Signature of the Director of the Examination and Appraisal Committce: 审批意见Viewpoints of Examination and Approval 段位主管部门盖章 Stamp of the Dept in Charge of the Duan Examination 审批日期： 年 月 日 Date of Approval : Date Month Year 中 国 武 术 协 会 制 Printed by the Chinese wushu Association