中国科学技术大学外国留学生入学申请表

Application Form for International Students

University of Science and Technology of China

地址：中国安徽合肥中国科学技术大学国际合作交流委员会 电话/Tel:86-551-63607981

Address：International Cooperation Committee 传真/Fax:86-551-63607982

University of Science and Technology of China 电子邮件/E-mail: presidentfellow@ustc.edu.cn

Hefei, Anhui 230026, China

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1. 姓名/Name

姓/Family Name 名/Given Name MIDDLE

2. 中文姓名/Chinese Name

姓/Family Name 名/Given Name

3. 国籍/Nationality 4. 护照号码/Passport No.

5. 性别/Sex 男/Male 女/Female 6. 婚姻状况/Marital Status

7. 出生日期(年/月/日)/Date of Birth(y/m/d) / / 8. 出生地点/Place of birth

州/省/State/Province, 国家/Country

9. 永久通讯地址/Permanent Home Address

传真/Fax 电话/Telephone

10. 目前通讯地址/Current Mailing Address if different From Permanent Address

传真/Fax 电话/Telephone 电子邮件/E-Mail

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14. 本人学历(从高中开始)/Educational Background (Starting from High School)

校名/Name 地点/Location 专业/Major 时间/Dates Attended 所获学位/Degree Awarded

15. 本人工作经历(从当前工作开始)/Work Experience (Starting from Current Position)

工作单位/Employer 地点/Location 时间/Dates Attended 职位/Position

16. 语言能力(用优、良、可)/Language Proficiency (Excellent, Good, or Fair)

语言/Language 读/Reading 写/Writing 说/Speaking

中文/Chinese

英语/English

17. 曾发表的作品和论文/Publications and Theses

18. 特长爱好/Special Skills or Interest

19. 在华学习或研究的详细计划，请另附页/Statement of Your Study or Research in USTC, Using a Separate Sheet.

20. 在华事务担保人姓名/Guarantor in China

地址及电话号码/Address & Tel

与申请人关系/Relationship with the Applicant 保证人签名/Guarantor’s Signature

申请人保证/I hereby affirm: 1. 上述情况真实无误。I have reviewed the above information, and it is true and complete to the best of my knowledge. 2. 在中国学习期间遵守中国政府的法律和学校的规章制度。I shall abide by the laws of the Chinese government and the regulations of the University.

申请人签字/Signature 日期/Date

中国科学技术大学外国留学生入学申请表-USTC