河西学院留学生“一带一路“沿线国家留学生校长专项奖学金申请表（中英）.doc

河西学院留学生“一带一路”沿线国家校长专项奖学金 申请表 （供申请入学的外国留学生申请奖学金用） Foreigner's Application Form for The President’s Scholarships of Hexi University (For International Students Applying for Admission to Hexi University) 1. 申请人基本情况/Personal Information of the Applicant 护照用名 姓 Passport Name Surname 名 Given Names 中文名 Chinese □ 男 性别 Name Male Gender 国籍 护照号码 Nationality Passport No. 出生日期 年/月/日 Birth Date Year/Month/Day □女 Female 出生地点 Birth Place 当前联系地址 Present Address 联系电话 传真 Tel Fax 电子邮件 QQ/ Email MSN 永久通信地址 Permanent Address 2. 申请学习类别和专业/The Program to Which the Applicant is Applying for Admission 申请学习类别 □ 语言进修生 Chinese Language Student Program to Apply for □ 本科生 Undergraduate □ 专科生 Junior College Students 申请学习专业 Major 申请学习院系 Departments/Schools 本栏可空缺 3. 申请奖学金类别/Type of Scholarships 申请人在河西学院学习期间的费用来源 (This column can be vacant) Financial Support for Your Study at Hexi University □自费 □本国政府奖学金 Self Government of Home Country □公司或机构 Company or Agency □ 派遣大学 Home University □其他（请说明） Others (Details required) ____________________ _____________________ 申请奖学金类别 Type of Scholarships for which You are Applying □ A 类 One Year Tuition Free: RMB14，000 元（Undergraduate），RMB10，000 元（Chinese Undergraduate） □ C 类 Excellent Student: 一等奖 4，400 元、二等奖 2，800 元、三等奖 1，600 元 First Prize RMB 4，000, Second Prize RMB2，800, Third Prize RMB1，600 注：奖学金不以现金方式支付，直接减免获奖学年内学费的相应金额。 Note: Scholarships are not payable in cash, award will be directly deducted from the amount of tuition of the corresponding school year. 4. 申请奖学金的相关材料/Supporting Information for Scholarship Application * This part can be carried over to next page. 获奖励情况和特长 Academic Honors and Distinctions 专业学习或研究经历 Research and Profession Experience 已发表的代表性论著或作品 Publications and Innovations 5. 申请人保证/I Hereby Affirm that: (1) 填写的上述内容和提供的材料真实无误； All the information and materials given in this form are true and correct; (2) 若获得奖学金资助，将按照规定履行岗位职责。 Once Approved, I shall fulfill the responsibility of the Scholarship positions. *填表时请参照《河西学院“一带一路”沿线国家留学生校长专项奖学金实施办法（暂行）》 *Please refer to “President Scholarship” for International Students Study in Hexi University (HXU) when fill in this form. 申请人签字 Signature of the Applicant ________________________ 日期 Date of Signature (Year/Month/Date) ________________________