Application Form for International Students in Qinghai University

2. 英文姓名

English Name: ________________

4.性别

Sex :_______

5.出生日期 年 月 日

Date of Birth: ____Y___M___D

6.宗教信仰

Religion:_______

7.出生地点/ Place of Birth

____________________

8.护照号码/ Passport No.

__________________

9.国籍/ Citizenship

______________

10.邮箱

Email Address:

11. 电话

Tel: ________________________________________________________

12.永久地址

Permanent Address: _____________________________________________

电话

____________________________________________ Tel: ____________

13.请按时间先后顺序填写本人中/高等教育学历

List in Chronological Order Your Secondary / higher Education

学校

Institution

在校时间(自…/至…)

Years Attended (From/To)

所获证书/学位

Diploma Received

主修专业

Field of Study

注: 请务必交验英文学历证书和英文成绩单复印件

Note: Copies of diploma and transcripts in English must be submitted.

14.汉语熟练程度(很好/好/一般/初级)

Chinese Proficiency (Excellent /Good /Fair/Beginning)

阅读 会话 书写

Reading ___________ Speaking __________ Writing __________

15.留学类别

Indicate the nature of the programme you wish to undertake in Qinghai University

(1).攻读学位/ Degree Programme

□本科生 □硕士研究生 □博士研究生

B.A./B.Sc. M.A./ M.Sc. PH.D

(2).不攻读学位/Non-degree Programme

□语言生 □普通进修生

Language Student Advanced Student

□高级进修生 □研究学者

Senior Advanced Student Research Scholar

16.请说明来青海大学学习/研究的主要目的。

Please describe the major purpose of your study/research in Qinghai University.

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

(2).学习/研究期限 自 年 月至 年 月

Duration of Study / Research: Fm____Y____M___D To ___Y___M___D

(3) 对学习/研究专业的补充说明 （研究生和高级进修生应用中文填写，

如本栏篇幅不够，可附另页）。

Any other information you consider relevant to this plan (postgraduate and

senior advanced students are requested to write in Chinese. Use a separate

page if necessary)

___________________________________ ________________________

___________________________________________________________

18．请注明你在青海大学学习/研究的经费来源。

Please specify the source of your financial support in Qinghai University.

中国政府来华留生奖学金资助

19．请附上有指导过你的教授（或学校校长、系主任）出具的两封推荐信,

请列出他们的姓名、职务/职称和地址。

Please submit two recommendation letters by professors (school principal

or department head) under whom you have studied. Please list their names,

positions /titles and addresses.

姓名

Name

职务/职称

Position of Title

地址

Address

20．是否曾在华学习过或工作过？如是，请说明并注明时间。

Have you previously studied or worked in China? If so, give details and dates.

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

21．工作简历

Present Occupation and Previous Employment

时间/ Date

工作单位/ Employer

职务，职称/Position, Title

22.在华事务联系人的姓名、地址和电话号码。

Name, address and telephone number of your reference in China to be notified in case of emergency.

姓名/ Name

地址/ Address

电话/ Tel.

23.家庭主要成员/ family members

姓名/ Name

关系/ Relation

年龄/ Age

申请人保证：

I hereby affirm that:

(1)上述各项中所提供的情况是真实无误的；

All the information given in this form is true and correct;

(2)在青海大学学习期间将遵守中国政府的法律和学校的规章制度。

I shall abide by the laws of the Chinese Government and the regulations of Qinghai University.

申请日期 申请人签名

Date: ______________ Signature : __________________

注 意： 不完整的申请表或未按要求交验的有关材料，将会延误对

此申请的审理。

IMPORTANT: An incomplete application or any short of supporting documents

WILL DELAY the process of admission.