护照用名

/Name in passport

姓/Family name  

中文名:

/Chinese name:

名/Given name  

国籍

/Nationality

护照号码

/Passport No.

出生日期

/Date of birth

    年     月       日

/year  /month   /date

男 □Male

女 □Female

已婚□Married

未婚□Single

出生地点

/Place of birth

宗教

/Religion

最后学历/ Highest education level

职业或身份/Occupation

工作或学习单位/Employer or school affiliated

学习语言

/study language

永久通讯地址/Permanent mailing address:

电话/Tel:                    传真/Fax:                   

E-mail:

目前通讯地址/Current address if different from above:

电话/Tel:                         传真/Fax:                 

E-mail:

申请学习时间

Study duration

从/from         年/Y     月/M      日/D  到/to             年/Y     月/M   日/D

现有汉语水平/Check the appropriate box to indicate the number of Chinese words you know.

  A  about 200    B  about 600   C  about 1000   D  over 2000 

申请学习专业/major:  □ Chinese    □ MBBS

申请学习类别/Program applied for:  □ 短期中文培训    □ 临床医学专业（本科）

经费来源保证人的通讯地址/电话/电子邮箱/

Sponsor’s mailing address /Tel/Email：

Mailing address:

Tel:

Email:

保证人签字/Sponsor’s signature:                                                                                                              

家庭情况/Family information and family members   

本人简历(从高中开始)/Curriculum vitae（Starting from high school）

宿舍预定/Reservation for dorm

单人间/Single：                               双人间/double：

我愿意到长沙医学院学习，在校学习期间保证做到下列各项：

1. 遵守中华人民共和国法律，包括宗教相关的法律法规。

2. 遵守学校的各项规章制度，努力学习，尊敬师长，友爱同学。

3. 按时缴纳学校规定的学生应该缴纳的各项费用。

4. 上述各项中填写的内容是真实无误的。

I am willing to study at Changsha Medical University.  I pledge the following terms during my study:

1. I will abide by the laws of the People’s Republic of China，including the laws and regulations for religions.

2. I will study industriously and observe all rules and regulations of the University, as well as respect all my teachers and get along well with my schoolmates.

3. I will pay all expenses on time.

4. All the information in this form is true and correct.

学生本人签字/Applicants signature

日期/Date 

申请人在递送本申请表的同时请提交：

Applicant should submit the following documents with the application form:

1.护照复印件。

Photocopy of your passport.

2.最后学历证书、学习成绩单。

Highest educational diploma, transcripts .

3.体检证明。Medical checkup certificate

4.无犯罪证明。Certificate of No criminal record provided by district police station.

5 白底二寸的电子照片。Two inches electronic photo with white background.