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中国国家留学基金管理委员会CHINASCHOLARSHIPCOUNCIL中国北京车公庄大街9号A3-13100044No.9A3-13chegongzhuangStreet,BeijingP.R.China100044,Tel:0086-10-66093900E-mail:laihua@csc.edu.cnFax:0086-10-66093915（TheabovetableisonlyforCSC）中国政府奖学金申请表APPLICATIONFORMFORCHINESEGOVERNMENTSCHOLARSHIP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。Pleasereadcarefullytheimportantnotesonthelastpagebeforefillingouttheform.PleasecompletetheforminChineseorEnglish.IftheformisnotfilledinonPC,pleasewritelegiblyinblackorblueink.Pleaseindicatewith‘X’intheblankchosen.Anyformsthatdonotfollowthenoteswillbeinvalid.1.申请人情况/PersonalInformation:护照用名/PassportName:姓/FamilyName:___________________________________________________名/GivenName:____________________________________________________国籍/Nationality:________________护照号码/PassportNo.:__________________出生日期/DateofBirth:年/Year_______月/Month_______日/Day_______出生地点/PlaceofBirth:国家/Country:_____________城市/City:_____________男/Male：□女/Female：□已婚/Married：□未婚/Single：□其它/Other：□母语/NativeLanguage:_______________________宗教/Religion:______________________________________当前联系地址/PresentAddress:___________________________________________________________________电话/Tel:_____________________传真/Fax:_____________________E-mail:________________________永久通信地址/PermanentAddress:_______________________________________________________________2.受教育情况/EducationBackground:学校Institutions在校时间YearsAttended(from/to)主修专业FieldsofStudy毕业证书及学位证书CertificatesObtainedorToObtain_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3.工作经历/EmploymentRecord:工作单位Employer起止时间Time(from/to)从事工作WorkEngaged职务及职称PostsHeld_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________CSCNO.派遣途径：学生类别：经费办法：学习专业：安排院校：1.2.3.照片Photo4.语言能力/LanguageProficiency: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/LevelofHSKtestorothercertificateswhichcanshowyourChineselevel:______________________________________________________________________________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/IcanbetaughtinEnglish:是/Yes□否/No□c).其他语言/OtherLanguages:___________________________________________________________________5.来华学习计划/ProposedStudyinChina:a).本科生/Bachelor’sDegreeCandidate：□硕士研究生/Master’sDegreeCandidate：□博士研究生/Doctor’sDegreeCandidate：□汉语进修生/ChineseLanguageStudent：：□普通进修生/GeneralScholar：□高级进修生/SeniorScholar：□b).申请来华学习专业或研究专题/SubjectorFieldofStudyinChina:____________________________________c).申请院校/PreferencesofInstitutionsofHigherEducationinChina:Ⅰ.________________________Ⅱ.________________________Ⅲ._______________________d).申请专业学习时间/DurationoftheMajorStudy:自/From：年/Year_________月/Month_________至/To：年/Year_________月/Month_________e).是否需要补习汉语/DoYouNeedElementaryChineseStudypriortotheMajorStudy?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’,pleaseindicatethedurationofyourelementaryChinesestudy(notincludedinthelengthofthemajorstudy).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）/PleaseDescribetheDetailsofyourStudyorResearchPlaninChina(anextrapapercanbeattachedifthisspaceisnotenough):__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7.曾发表的主要学术论文、著作及作品/AcademicPapers,Writing&ArtWorksPublished:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________8.申请奖学金类别/ScholarshipApplied:A.全额奖学金/FullScholarship:□B.部分奖学金/PartialScholarship:学费/Tuition:□住宿费/Accommodation:□医疗费/MedicalCare:□教材费/LearningMaterials:□9.推荐您申请中国政府奖学金的机构或个人/PleaseSpecifytheOrganizationorPersonRecommendingyouforthisScholarship:_______________________________________________________________________________10.申请人在华事务联系人或机构/TheGuarantorChargingYourCaseinChina: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/HaveyoueverStudiedorWorkedinChina?是/Yes:□学习或任职单位/InstitutionorEmployer:_________________________________________________在华时间/TimeinChina:自/From:年/Year_____月/Month_____至/To:年/Year_____月/Month____否/No:□12.申请人亲属情况/FamilyMembersoftheApplicants:姓名年龄职业NameAgeEmployment配偶/Spouse:__________________________