北京科技大学1校长奖学金评审表

北京科技大学校长奖学金申请表

APPLICATION FORM FOR CHANCELLOR’S SCHOLARSHIP

请申请人认真阅读本表第四页的填表说明。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.

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 Institutions Years Attended Fields of Study Certificates Obtained or

(from/to) 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：□

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:______________________________________________________________________________ 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/Proposed Study in China:

a).硕士研究生/Master’s Degree Candidate：□ 博士研究生/Doctor’s Degree Candidate：□

b).申请来华学习专业或研究专题/Subject or Field of Study in China:____________________________________ c).申请专业学习时间/Duration of the Major Study:

自/From：年/Year_________月/Month _________ 至/To：年/Year_________月/Month _________ e).是否需要补习汉语/Do You Need Elementary Chinese Study prior to the Major Study?

是/Yes：□ 请填写申请汉语补习时间（不计在专业学习时间内）/ If ‘Yes’, please indicate the duration of

your elementary Chinese study(not included in the length of the major study).

自/From：年/Year_______月/Month ________ 至/To：年/Year________月/Month ________

否/No：□

6. 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

(an extra paper can be attached if this space is not enough):

______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

7. 曾发表的主要学术论文、著作及作品/Academic Papers, Writing & Art Works Published:

______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

8. 申请奖学金类别/Scholarship Applied:

A. 全额奖学金/Full Scholarship: □

学费/Tuition:□ 住宿费/Accommodation:□ 医疗费/Medical Care:□ 教材费/Learning Materials:□

9. 推荐您申请校长奖学金的机构或个人/Please Specify the Organization or Person Recommending you for this

Scholarship: _______________________________________________________________________________

10. 申请人在华事务联系人或机构/The Guarantor Charging Your Case in China:

名称/Name:_______________________________ 电话/Tel:_________________ 传真/Fax:_________________ 地址/Address:_________________________________________________________________________________

11. 申请人是否曾在华学习或任职/Have you ever Studied or Worked in China?

是/Yes:□ 学习或任职单位/Institution or Employer: _________________________________________________

在华时间/Time in China: 自/From:年/Year_____月/Month _____至/To:年/Year_____月/Month ____

否/No:□

12. 申请人亲属情况/Family Members of the Applicants:

姓 名 年 龄 职 业

Name Age Employment

配偶/Spouse: __________________________ ______________ _____________________________

父亲/Father : __________________________ ______________ _____________________________ 母亲/Mother: __________________________ ______________ _____________________________ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡  所附材料情况（请在所附附件前划‘X’标明）/Materials Attached (Please Indicate with ‘X’in the Bracket.):

□ 申请表（一式两份）/ Application Form (in duplicate).

□ 两封推荐信/Two Letters of Recommendation.

□ 有关中国院校接受函或录取通知书/Admission Letter or Admission Notice of Chinese Universities.

□ 本人最后学历成绩单复印件（须公证，一式两份）/Transcripts of the Most Advanced Studies (Notarized Photocopy).

□ 本人最后学历证书复印件（须公证，一式两份）/Diploma of the Most Advanced Studies (Notarized Photocopy)：

本科/Bachelor’s □ 硕士/Master’s □ 博士/Doctor’s □ 其它/Others □

□ 外国人体格检查记录（复印件）/ Foreigner Physical Examination Form (Photocopy).

□ 来华学习计划/ Study Plan in China.

□ 所发表的文章等/ Articles or Papers Written or Published.

/Examples □ 美术作品（本人作品彩照六张）、音乐作品（本人音乐作品盒式录音带一盘）（只限申请美术和音乐专业的申请人）

of Art (6 color pictures) and Music (1 audio tape) Work (Only for the applicants applying for Fine Arts and Music).

□ 其它附件（请列出）/Other Attachments (List Needed)：__________________________________________________________ 注：每份申请材料最多不超过20页，请全部使用A4纸。

Each set of the complete materials should not exceed 20 pages. Please use DIN A4.

无论申请人是否被录取，上述申请材料恕不退还。

Whether the candidates are accepted or not, all the application materials will not be returned.

 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. 来华后服从北京科技大学所安排的就读学习专业，不得无故要求变更学校和所学专业；

I will agree to the arrangements of my institution and specialty of study in China, and will not apply for any changes in these two fields 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 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. 按照规定参加北京科技大学校长奖学金年度评审；

I shall go through the procedures of the Annual Review of Chancellor’s Scholarship Status as required.

6. 按规定期限修完学业，按期回国，不无故在华滞留；

I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid

reasons.

7. 如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受北京科技大学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 of the University Science and Technology Beijing 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）