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大连民族大学国际文化交流学院留学申请表InternationalCultureExchangeInstituteAPPLICATIONFORADMISSIONDalianMinzuUniversity请用中文或英文填写PleasewriteclearlyinChineseorinEnglish.
请在选择的地方划'√'Pleasedrawthe'√'intheselectedplace.
1.
个人信息PersonalInformation母语:MotherTongue:英文姓名EnglishName姓Surname名Givenname照片3个月以内摄影6张6CopiesofphotoTakenwithintheLast3months4.
5x3.
5cm中文姓名ChineseName国籍Nationality性别Sex男Male婚姻情况MaritalStatus已婚Married女Female未婚Single出生年月DateofBirth年月日YearMonthDay护照Passport有Yes宗教Religion申请中ApplyingFor护照号码PassportNo.
有效期限DateofExpiration银行卡号(中国)NumberofBankCard(China)现住所HomeAddress电话PhoneNo.
微信WeChat/QQ2.
教育背景EducationBackground教育层次Educationlevel学校名称NameofSchool在校时间(年/月-年/月)Timeatschool(mm/dd—mm/dd)高中Seniorhighschool大学University3.
职业经历OccupationalExperience有Yes()无No()工作单位名称NameoftheCompany所在地Location职务Position工作时间PeriodofEmployment年月日YearMonthDay4.
留学渠道Supportedby奖学金生ScholarshipStudent个人自费Self-support企业资助Enterprisesupport校际交换ExchangeStudent6.
家庭成员FamilyMembers姓名Name与本人关系Relationship工作单位及职务Company&Position电话Tel邮箱E-mail丈夫/妻子Husband/Wife父亲/母亲Father/Mother7.
在华联系人GuarantorinChina有Yes()无No()姓名FullName性别Sex出生日期DateofBirth年月日YearMonthDay与本人关系Relationship职业Occupation住所PresentAddress电话(PhoneNo):8.
学习汉语的经历ChineseStudyExperience有Yes()无No()学习时间TotalTimeofStudy周学时数HoursPerWeek汉语水平等级LevelofChinese学习方式WaysofStudy学习地点PlaceofStudy()Year()Months9.
计划在华学习时间IntendedLengthofStudyinChina计划学习时间IntendedLengthofStudy计划学习起止时间From()to()()Year()Month10.
计划参加何种程度的汉语学习DesiredLevelofChineseStudy入门班ClassForBeginners初级班PrimaryClass中级班IntermediateClass高级班AdvancedClass本科班Undergraduateclass11.
住宿要求RequestforAccommodation校内宿舍IntheUniversity单人间SingleRoom$70/perday双人间DoubleRoom$35/perday校外租房OutsideofUniversity个人租房SingleRent合伙租房RentWithOthers申请人保证上述各项信息真实无误,在大连民族大学学习期间保证遵守中华人民共和国法律及学校的规章制度.
Iherebyaffirmthatalltheinformationistrueandcorrect.
IagreetoobeytheuniversityrulesandthelawsofthePeople'sRepublicofChina.
签名年月日SignatureYearMonthDay