Chinese Name

中  文  名

English Name

(as shown on your passport)

 英文名（與護(hù)照一致）

Family Names姓         Given Names名

Nationality

國    籍

Gender

性    別

Male男 □

Female女 □

Marital Status

婚姻狀況

Single單身□Married已婚   □

Divorced 離異   □

Place of birth

出生地

Date of birth

出生日期

PassportNo.

護(hù)照號碼

Passport Valid

護(hù)照有效期

Highest Education

LevelObtained

最后學(xué)歷

Student Category

學(xué)生類別

□Four -year Students with diploma     

□Chinese Language Student

□Exchange Student

□Other _________   

Which School do you study in QNU?

所在學(xué)院

Which Major do

you study inQNU

學(xué)習(xí)的專業(yè)

Study Period inQNU

學(xué)習(xí)時間

From:To:         (yy/mm/dd)

從：         至：          (年/月/日)

Financial Support

經(jīng)費(fèi)來源

□ Self-supported Student  自費(fèi)生                                        

Tuition：_________ RMB /Academic year

Scholarship class applied

申請獎學(xué)金等級

□first-class scholarship   一等獎學(xué)金  

□second-class scholarship 二等獎學(xué)金

□third-class scholarship   三等獎學(xué)金

Contact information

聯(lián)系方式

Wechat No.微信號

Mobile手機(jī)

Email電郵

Postal Address通訊地址

Self-evaluation

自我評價

Study Plan

學(xué)習(xí)計劃

Applicant’s Signature                                                       Date

申請人簽名                                                              日期：

Notice:  Please print the two pages of the form on the same paper.