
 中国421001  湖南省衡阳市市常胜西路28号                                          此处无需填写(Do not write in this space)
 International College, University of South China
 Hengyang, Hunan 421001, China
  
                                                    球盟会国际员工学习申请表
             International Student’s Application for Study in University of South China
 
  
   
    申请人信息 The   Applicant’s Information  | 
    照片 Photo  | 
   
   
    姓名 Name  | 
    姓/Family Name:  | 
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    名/Given Name:  | 
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    国籍 Nationality  | 
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    性别 Sex  | 
    男Male  □  | 
    婚姻状况 Marital Status  | 
    单身 Single □  | 
   
   
    女 Female□  | 
    已婚Married □  | 
   
   
    出生日期 Date of Birth  | 
    年     月     日 Year   month   date  | 
    出生地点 Place of Birth  | 
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    健康状况 Health Status  | 
    一般 Average □   好 Good   □  | 
    宗教信仰 Religion  | 
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    文化程度 Education Level  | 
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    护照号码 Passport No.  | 
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    护照有效期 Valid until   | 
            年       月      日        Year    month   day   | 
   
   
    通讯地址 Mailing Address  | 
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    电话 Tel 邮箱 E-mail  | 
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      家庭住址 Home Add.  | 
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    员工申请类别 Student Status  | 
    语言进修生   Chinese Language Student□   本科生Undergraduate□      研究生 Postgraduate □  | 
   
   
    学习期限:自       年         月   至     年       月 Duration:   From     year    month  to       year    month  | 
    学习专业: Field of Study :  | 
   
   
    申请人教育背景   The Applicant’s   Educational Background  | 
   
   
    本人简历(从高中开始)/Curriculum vitae   (Starting from high school) 
     
      
       
        
         单位 Previous and current education & employer  | 
         时间(年月——年月) Duration(from/to)  | 
         职务 Position  | 
         
        
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      现有汉语水平/Current   Chinese Language Proficiency (Mark the following option about how many   Chinese characters you have grasped) A. about 200     B. about 600     C .about 1000     D. over 2000   E. None  | 
   
   
    现有英语水平/   Current English Proficiency A. Native    B.   Fluent    C. Communicable   D. Poor  | 
   
   
    学习经费来源/Sources of Funding for the Study  □自费/Self-Supporting       □奖学金/Scholarship   □其他/Other  | 
   
   
    推荐人信息 The Reference’s Information  | 
   
   
    姓名/Full Name  | 
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    职业/Occupation  | 
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    电话/Tel  | 
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    推荐人承诺 The Reference’s Statement  | 
   
   
    I hereby verify that the information   provided by the applicant about his/her educational background is true and   authentic.                Signature:                                       Date:  | 
   
   
    申请人家庭信息The Applicant’s Family Information   | 
   
   
    家庭情况/Family   information and family members 
     
      
       
        姓名 /Name  | 
        与申请人关系/ Relationship     with the applicant  | 
        职业/profession  | 
        电话和电子邮件/ Tel.&     E-mail  | 
        家庭年收入/ Annual     household income  | 
        
       
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        Tel: E-mail:  | 
        A.USD$8000-10000 □ B.USD$10000-15000□ C.USD$15000-20000□ D.USD$20000-30000□ E.Above USD$30000□  | 
        
       
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        Tel: E-mail:  | 
        
       
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    家人经济担保证明   The Family’s   Statement of Financial Support  | 
   
   
    I hereby promise that I and my family have fully   understood the prospective cost for and have the capacity to support the applicant   to finish his/her educational program in the University of South China and   will pay all fees timely and adequately.                              Name ( in printed style)   :            Relationship with the applicant:                      Signature   :                           Date :  | 
   
   
    申请人声明 The Applicant’s Statement  | 
   
   
      申请人保证 I hereby affirm that: 1. 上述各项中所提供的情况真实无误。 All the information I provided above is true and   correct. 2.在华学习期间遵守中国的法律和公司的规章制度。 I shall abide by   the laws of China Government and regulations of the University of South   China. 3.按时交纳公司规定的各种费用。 I will pay all the expenses prescribed by the   university on time.   申请人签名:                            日期:       年       月         日 Signature:                                  Date:        year       month    day    | 
   
   
    申请人在递交本表的同时递交:Applicant should submit the following documents along with the   applicant form: 1、 经过公证的最高学历证明和成绩单 Transcript of   the highest education (Notarized photocopy); Diploma of the highest education   (Notarized photocopy) 2、 两名教授或副教授的推荐信(研究生) Two reference   letters from professors or associate professors ( For the post-graduate or   doctorate candidates) 3、 护照复印件 Photocopy of   the passport 4、 六个月内的体检证明 Physical Examination   Form within 6 months (Photocopy). 5、 经过公证的无犯罪证明 Notarized   Certificate of Non-criminal Record (Photocopy). 白底两寸的电子照片 One two-inch   electronic photo with white background (Passport Photo Size)    | 
   
   
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