中国矿业大学来华留学奖学金介绍

个人信息/ Personal Information (Please type or print clearly and answer all questions)

姓/Family Name

名/Given Name

照片

photo

中文姓名/ Chinese

Name (If any)

国籍/Nationality

出生日期/ Date of

Birth (mm/dd/yyyy)

出生地点/

Place of Birth

护照号码/

Passport No.

有效期/

Expiration Date

性别/Gender

□ 男/ Male   □ 女/ Female

母语/

Native Language

宗教/Religion

邮箱/Email Address

目前居住地/Are you currently residing in China? □Yes  □No  If yes, what is your VISA status?　□X  □ L  □Z  □F

婚姻状况/Marital Status

□ 单身/ Single              □ 已婚/ Married               □ 离异/ Divorced

家庭永久通讯地址/ Permanent/Home Country Address: 街道门牌号/Street or Road No.                                        

城市/City                              州/State                          国家/Country                                   

邮编/Zip Code                          电话/Tel:                         手机/Cell Phone                            

目前邮寄地址 Current Mailing Address：街道门牌号/Dept, Street or Road No.                                       　      

       　　 　     　  城市/City                         州/State               国家/Country                                   

邮编/Zip Code                   电话/Tel:                         手机/Cell Phone                             

紧急联系人/ Person to Notify in Case of Emergency:  Name                            Relationship to you                  

Tel. & Address (street/city/state or country/zip code):                                                                         

教育背景(小学除外)/List all educational institutions attended (excluding primary school)

高中学校名称 /Name of High School                                                        Self-reported GPA__________

城市及国家 /City & Country                                                                                                                                                      

在校时间/Date of Attendance (from/to month/year)                 毕业时间/Year of Graduation (or expected date)                                     

所获证书/Name of Diploma or Certificate                                                                                                

大学学校名称 /Name of Institution (College/University)                                                                                        

城市及国家/ City & Country                                                                                                                                                       

在校时间/ Date of Attendance (from/to month/year)                    毕业时间/Year of Graduation (or expected date)                                     

所获证书/ Name of Diploma or Certificate                                                                             

大学学校名称 /Name of Institution (College/University)                                                                                         

城市及国家/ City & Country                                                                                                                                                       

在校时间/ Date of Attendance (from/to month/year)                    毕业时间/Year of Graduation (or expected date)                                     

所获证书/ Name of Diploma or Certificate                                                                             

大学学习排名Academic Ranking in Class (List Last College/ Univ. Attended):

□前10%/Top 10%  □前20%/Top 20%  □前30%/Top 30%  □一般/Average □低于平均水平/Below the Average

工作经历 Work Experience（if any）

单位/Employer                                  时间Date(from to)                          职务/Job Title

来华学习经济来源/ Source of Funding: □ 奖学金/Scholarship  □  自费/Self-Supporting   □  其他/Other 

是否申请中国矿业大学奖学金/ Applying CUMT Scholarship:   □  是/Yes □否/No

在华担保人信息

Guarantor Information in China

姓/Family Name:                            名/Given Name:_________________________ 

电话/Tel:         区号/area code                     号码/number

推荐单位/人信息

Reference &Tel.（if any）

单位名称或推荐人/Name of Organization or Referrer:                                 

                                 电话/Tel:                                      

汉语语言能力

Chinese Language Proficiency

是否已参加HSK考试？/ Have you taken HSK test?

□是/Yes □否/No            等级及分数/HSK Level & Score:                       

英语语言能力

English Language Proficiency

  □  很好/excellent       □好/good       □一般/fair       □不会/beginning

掌握其他语种/List other language you write or speak:

来华学习计划You Are Applying for:

1. □  短期汉语培训/Short-term Chinese Language Program (秋季Fall Semester (Sept–Jan.); 春季Spring ( Feb – June )

2. □  预科汉语培训/Pre-University Chinese Language Program  

3. □  本科/Undergraduate Program                               4. □硕士研究/Master Program

5. □  博士研究/ PhD Program                                   6. □进修/ Advanced Program

你是否申请中国矿业大学奖学金/ Are you applying for CUMT Scholarship? □是/Yes  □否/No  

申请类别/Scholarship Type：□A类  □B类      

学校不提供奖学金你愿意自费留学吗？/Are you still applying for without CUMT Scholarship?   □是/Yes    □否/No

申请专业

Major You Are Applying for

入学时间Apply for Semester and Year for Chinese Language, Degree & Advanced Program

□秋季/Fall Semester (Sept.) ,Year       ； □春季/Spring Semester (Feb.), Year        (只对进修生/ Only for Advanced Program)

您是如何知道我校？/ How do you get to know about our university?  □朋友/Friend  □网络/Internet □其他/other

□中介/Agency , If yes, give the name of the agent:

补充说明/Additional information you consider important to this application:

校内住宿信息/Accommodation on Campus Housing Intended:    □  Yes    □No  If yes, please fill out housing applcation form.

申请人仔细阅读并保证/Read carefully and affirm that:

1. 上述各项中所提供的情况是真实无误的；

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，尊重学校的教学安排。及时交纳

学校规定的学费、书费、住校所涉及的住宿费及相关费用。

1. All the information in this form is true and correct;

2. All the answers I have given in this application are complete and accurate to the best of my

knowledge. If admitted, I agree to observe all the rules and regulations of the Chinese Government

and CUMT. I understand I will be responsible for payment of all amounts I owe the University, i.e.

tuition, fees, fines, rents, citations, etc.

签名/ Signature:                                日期/Date(mm/dd/yyyy)             

以下内容仅供我校相关部门填写(Office Use Only)

申请人编号：

接受申请日期：

国际学院意见：