1.申请人情况/Personal Information

中文名字/Chinese Name:

护照用名/Passport Name:

国籍/ Nationality: 护照号码/ Passport No.:

出生日期/Date of Birth:年/ Year: 月/ Month 日/ Day

出生地点/ Place of Birth:国家/Country: 城市/City:

性别/Gender：男/Male□ 女/Female□

婚姻状况/Marital Status：已婚/Married□ 未婚/Single□ 其它/Other□

母语/Native Language： 宗教/Religion：

当前联系地址/ Present Address:

电话/Tel: 传真/Fax: 邮箱/E-mail:

永久通信地址/Permanent Address:

2.受教育情况/Education Background

学校 在校时间 主修专业 毕业证书及学位证书

Institution YearsAttended (from/to) Fields of Study Certificates Obtained or To Obtain

3.工作经历/Employment Record

工作单位 起止时间 从事工作 职务及职称

Employer Time (from/to) Work Engaged Posts Held

4.语言能力/Language Proficiency

a)汉语/Chinese: 很好/Excellent□ 好/Good□ 较好/Fair□ 差/Poor□ 不会/None□

HSK考试等级Level of HSK：

b)英语/English: 很好/Excellent□ 好/Good□ 较好/Fair□ 差/Poor□ 不会/None□

c)其他语言/Other Languages:

5.来华学习计划/Proposed Study in China

a) 本科生/Undergraduate Students £ 汉语进修生/Chinese Language Student £

b)申请来华学习专业/Major of Study in CQUE:____________________________________________________________

c)申请来华专业学习时间/Duration of the Major Study in China:

自/From: 年/Year _________月/Month___________ 至/ To: 年/Year_________ 月/Month___________

6. 申请奖学金类别/Category of Scholarship You Apply For

一等奖/First prize £ 二等奖/Second prize £

7. 在华学习计划陈述（可另附纸）/Please Describe Your Future Study Plan in CQUE(An extra paper can be attached if this space is notenough.)

8.曾发表的主要学术论文、著作及作品/Academic Papers, Writing & Art Works Published

所附材料情况（请在所附附件前划‘X’标明）/Materials Attached (Please Indicate with‘X’ in the Bracket.)

□ 本人护照信息页复印件/Personal Information Page of Passport（Photocopy）

□ 在华学习计划/Study Plan in China(Either in Chinese or in English)

□ 汉语水平考试成绩单（Transcript of HSK）

□ 所发表的文章等/ Articles or Papers Written or Published (Photocopy)

□ 其它附件（请列出）/Other Attachments

注：1）全部使用A4纸准备所有申请材料；Please use DIN A4 to prepare all the application materials；

2)无论申请人是否被录取，所有申请材料恕不退还。Whether the candidates are accepted or not, all the application materials will not be returned.

申请人保证/I Hereby Affirm That:.

1.申请表中所填写的内容和提供的材料真实无误；

All the information and materials given in this form are true and correct.

2.在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动；

During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate inactivities in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student.

3.在学期间，遵守学校的校纪、校规，全力投入学习和研究工作，尊重学校的教学安排；

During my study in China, I shall abide by the rules and regulations of the hostuniversity concentrate on my study and researches and follow the teaching programs arranged by the university.

4.按照规定参加重庆第二师范学院校长奖学金年度评审；

I will go through the procedures of the Annual Evaluation ofCQUE President Scholarship as required.

5.按规定期限修完学业，按期回国，不无故在华滞留；

I shall return to my home country as soon as I complete my scheduledprogram in China and will not extend my stay without valid reasons.

6.我保证，未同时接受其它任何渠道的奖学金或资助；

I declare that this is the only Scholarship I am applying for at present.

7.如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受重庆第二师范学院中止或取消奖学金及其它相应的处罚。

If I am judged by the Chinese laws, decrees and the rules and regulations of theUniversity for having violated any of the above, I will not lodge any appeal against the decision ofChongqing University of Education on suspending, withdrawing or other penalties.

申请人签字/Signature of Applicant: 日期/Date:

(无此签名，申请无效/The application is invalid without the applicant’s signature )