南京市政府外国留学生奖学金申请表.doc

附件二： 南京市政府外国留学生奖学金申请表 APPLICATION FORM FOR NANJING GOVERNMENT SCHOLARSHIP FOR INTERNATIONAL STUDENTS 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‘√’表示。不按规定 填写的表格将视作无效。 Please complete the form in Chinese or English. Fill the form on PC or write neatly in black or blue ink. Tick where applicable . Any form that does not follow the notes will be invalid. 1、申请人情况/Personal Information： 护照用名/Passport Name： 照片 Photo 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：_____________ 男/Male：□ 城市/City：_____________ 女/Female：□ 已婚/Married：□ 未婚/Single：□ 其它/Other：□ 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 ： _______________________________________________________________ 电 话 /Tel ： _____________________ 传 真 /Fax ： _____________________ E-mail ： ________________________ 2、本人简历(从高中开始)/Curriculum Vitae（Starting from high school） 单 位 时间（年/月—年/月） Previous and Current Education & Employer Years Attended (from/to) ________________________________________ 主修专业 Fields of Study _____________________ ______________________ ________________________________________ ______________________ 1 _____________________ ________________________________________ _____________________ ______________________ 3、汉语能力/Language Proficiency： 很好/Excellent：□ 好/Good：□ 较好/Fair：□ 差/Poor：□ 不会/None：□ HSK 考试等级或其他类型汉语考试成绩/ Level of HSK test or other certificates which can show your Chinese level ： ______________________________________________________________________________ 4、来华学习计划/Proposed Study in China： a).本科生/Bachelor’s Degree Candidate： □ 博士研究生/Doctor’s Degree Candidate：□ 硕士研究生/Master’s Degree Candidate：□ 非学历教育/Non-Degree Programs’ Candidate：□ b).拟申请学校/University in Nanjing applied for：____________________________________________ c). 申 请 来 华 学 习 专 业 或 研 究 专 题 /Subject or Field of Study in China ： ____________________________________ d).申请专业学习时间/Duration of Study： 自 /From ： 年 /Year_________ 月 /Month _________ 至 /To ： 年 /Year_________ 月 /Month _________ 5、拟在华学习或研究的详细内容（可另附纸）/ Please describe the details of your study or research plan in China (Extra paper can be attached if this space is not enough)： _______________________________________________________________________________________ _______ _______________________________________________________________________________________ _______ _______________________________________________________________________________________ _______ 6、曾发表的主要学术论文、著作及作品/Academic Papers, Writing & Art Works Published： _______________________________________________________________________________________ _______ _______________________________________________________________________________________ _______ _______________________________________________________________________________________ 2 _______ 7 、推荐您申请南京市政府留学生奖学金的机构或个人/ Organization or person recommending you for this scholarship ： _________________________________________________________________________________ 8、申请人在华事务联系人或机构/Guarantor or emergency contact in China： 名 称 /Name ： ______________________________ 电 话 /Tel ： _________________ 传 真 /Fax ： _________________ 地 /Address 址 ： _________________________________________________________________________________ 9、申请人亲属情况/Family Members of the Applicant： 姓 名 年 Name 配 偶 /Spouse 龄 Age __________________________ ： 职 业 Employment ______________ _____________________________ 父 亲 /Father ： __________________________ ______________ __________________________ ______________ _____________________________ 母 亲 /Mother ： _____________________________ ·所附材料说明（请在所附附件前划“√”标明）：Materials Attached (Please tick where applicable .): □ 两封推荐信/Two Letters of Recommendation. □ 本人最后学历成绩单复印件/ Transcripts of the Most Advanced Studies. □ 本人最后学历证书复印件/ Diploma of the Most Advanced Studies. 本科/Bachelor’s □ 硕士/Master’s □ 博士/Doctor’s □ 其它/Others □ □ 来华学习计划/ Study Plan in China. □ 护照复印件./ A Photocopy of the Applicant’s Passport; □ 担保人有效证件的复印件/ A photocopy of the guarantor’ certification (can be a passport, license, or other official ID). □ HSK 证书复印件/ A photocopy of HSK certificate. 3 ·申请人保证/I Hereby Affirm That: 1、申请表中所填写的内容和提供的材料真实无误； All information and materials given in this form are true and correct. 2、在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动； During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate in any activities in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student. 3、来华后服从学校的安排，不得无故要求变更学校和所学专业； I will agree to the arrangements of my institution in Nanjing and will not change university or specialty of study without valid reasons. 4、在学期间，遵守学校的校纪、校规，全力投入学习和研究工作。尊重学校的教学安排； During my study in China, I shall abide by the rules and regulations of the host university, and concentrate on my studies and researches, and follow the teaching programs arranged by the university. 5、如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受中止或取消奖学金及其它相应的 处罚。 If I am judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above, I will not lodge any appeal against the decision on suspending, or withdrawing my scholarship, or other penalties. 申 请 人 签 字 /Signature of the Applicant:____________________________ 日 期 /Date:___________ （无此签名，申请无效/The application is invalid without the applicant’s signature.） 4 5