Scholarship- Application Form

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SCHOLARSHIP- APPLICATION FORM.

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嘉兴学院汉语语言文化项目申请表
Application Form for Chinese Language Scholarship at Jiaxing University
请用英文提供以下信息,并打印。 /Please provide following information and type in English.

1. 申请人情况/Personal information
护照名/Passport Name (if any):
姓/Last Name (Surname): _____________________________________
名/Given Name(s): ____________________________________________________________________
性别/Gender: _______ 出生日期/Date of birth: ____________________
宗教 Religion__________________________
国籍/Nationality: _______________ 护照号码/Passport Number: _______________________________
护照有效期/Passport Expiration Date: ______________________________
年级/Grade/Year: ____________学校/学院 School/Institution: _________________________________
第一语言/First Language: _________________第二语言/Second Language: ______________________
其他语言/Other languages you know:______________________________________________________
当前地址/Current Address: 省 /Region: ___________________ 市/District: _______________________
邮寄地址/Postal Address: _______________________________________________________________
电话/Phone: __________________________ 传真/Fax: _______________________________________
手机/Mobile: _________________________ 邮箱 /Email: _____________________________________
如果有任何艺术特长,请详述。 /If you have any artistic skills, please specify: ___________________
_____________________________________________________________________________________
如果有任何食物禁忌,请详述。 /If you have taboo food, please specify.
_____________________________________________________________________________________
____________________________________________________________________________________

2. 紧急联络人信息 Contact person in case of emergency
联络人 1/Contact #1
姓名/Name: _____________________________ 家庭电话/Home Phone: _________________________
办公电话/Office Phone: ________________ 手机/Mobile Phone: _______________________________
联络人 2/Contact #2
姓名/Name: _____________________________ 家庭电话/Home Phone: _________________________
办公电话/Office Phone: _______________ 手机/ Mobile Phone: _______________________________
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3. 汉语水平/Chinese Language Proficiency
学习中文多长时间? / How long have you been learning Chinese?
_____________________________________________________________________________________
中文水平/Chinese Language Proficiency (Basic, Intermediate, Advanced):
_____________________________________________________________________________
是否来过中国? /Have you been to China before? 是/Yes 否/No 如果是,何时来过中国 If yes, when?
________________________________

4. 医疗信息/Medical Information
(a) 你目前是否在接受治疗? /Are you currently receiving medical treatment?
是/Yes ( ) 否/No ( )

如果是,请解释/If yes, please explain: ________________________________

____________________________________________________________________________________
(b) 你目前是否在接受心理咨询或治疗? /Are you currently receiving counseling or medication for any
psychological or emotional conditions?
是/Yes ( ) 否/No ( )
如果是,请解释/If yes, please explain____________________________________________________
___________________________________________________________________________________
(3)你是否有任何过敏? /Do you have any allergies?
是/Yes 否/No
如果是,请解释/If yes, please explain____________________________________________________
___________________________________________________________________________________
5. 请陈述申请参加嘉兴学院汉语语言文化项目的原因(可附一页详细说明,最多 250 字)。
/Please state the reasons why you would like to study Chinese language at Jiaxing University (You
may attach a separate sheet, maximum 250 words).
………………………………………………………………………………………………..………………………………………………………
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………………………………………………………………………………………..………………………………………………………………
……………………………………………………………………………………..…………………………………………………………………
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申请人声明/Declaration of applicant:
我特此证明:/ I hereby certify that:
本表所填写的内容和提供的材料真实无误。 /All the information on this form is true and correct.
申请人签字/Signature of Applicant: ………………..……………………………………….………………..…………………
日期/Date: …………………..…………………………………………………………………..…………………………………………………..………………
(手写/Handwriting)
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