黑 龍 江 省 政 府 獎(jiǎng) 學(xué) 金 申 請(qǐng) 表

1、黑龍江省政府獎(jiǎng)學(xué)金申請(qǐng)表APPLICATIONFMFHEILONGJIANGGOVERNMENTSCHOLARSHIP請(qǐng)申請(qǐng)人認(rèn)真閱讀本表第四頁(yè)的填表說(shuō)明。請(qǐng)用中文或英文填寫(xiě)此表格。請(qǐng)用電腦打印或用藍(lán)色或黑色鋼筆認(rèn)真書(shū)寫(xiě)表格內(nèi)容。請(qǐng)?jiān)谒x項(xiàng)框內(nèi)劃‘X’表示。不按規(guī)定填寫(xiě)的表格將視作無(wú)效。Pleasereadcarefullytheimptantnotesonthelastpagebefefillingoutthefm.Pleasecom

2、pletethefminChineseEnglish.IfthefmisnotfilledinonPCpleasewritelegiblyinblackblueink.Pleaseindicatewith‘X’intheblankchosen.Anyfmsthatdonotfollowthenoteswillbeinvalid.1.申請(qǐng)人情況PersonalInfmation:護(hù)照用名PassptName:姓FamilyName:___

3、__________________________________________名GivenName:______________________________________________國(guó)籍Nationality:________________護(hù)照號(hào)碼PassptNo.:_________________出生日期DateofBirth:年Year_______月Month_______日Day_______出生地點(diǎn)Plac

4、eofBirth:國(guó)家Country:_____________城市City:_____________男Male：□女Female：□已婚Married：□未婚Single：□其它Other：□母語(yǔ)NativeLanguage:______________________宗教Religion:______________________________________當(dāng)前聯(lián)系地址PresentAddress:_____________

5、____________________________________________________電話Tel:_____________________傳真Fax:_____________________Email:________________________永久通信地址PermanentAddress:_____________________________________________________________

6、_2.受教育情況EducationBackground:學(xué)校在校時(shí)間主修專(zhuān)業(yè)畢業(yè)證書(shū)及學(xué)位證書(shū)InstitutionsYearsAttendedFieldsofStudyCertificatesObtained(fromto)ToObtain___________________________________________________________________________________________________

7、______________________________________________________________________________________________________________________________________________________3.工作經(jīng)歷EmploymentRecd:工作單位起止時(shí)間從事工作職務(wù)及職稱(chēng)EmployerTime(fromto)WkEngagedPos

8、tsHeld______________________________________________________________________________________________________________________________________________________________________NO.照片Photo11.申請(qǐng)人是否曾在華學(xué)習(xí)或任職HaveyoueverStudiedWked

9、inChina是Yes:□學(xué)習(xí)或任職單位InstitutionEmployer:____________________________________________在華時(shí)間TimeinChina:自From:年Year____月Month____至To:年Year____月Month____否No:□12.申請(qǐng)人親屬情況FamilyMembersoftheApplicants:姓名年齡職業(yè)NameAgeEmployment配偶Spo

10、use:_____________________________________________________________________父親Father:_____________________________________________________________________母親Mother:____________________________________________________________

11、_________﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡?所附材料情況所附材料情況（請(qǐng)?jiān)谒礁郊皠潯甔’標(biāo)明）MaterialsAttached(PleaseIndicatewith‘X’intheBracket.):□申請(qǐng)表（一式兩份）ApplicationFm(induplicate).□兩封推薦信TwoLettersofRecommendation.□有關(guān)中國(guó)院校接受函或錄取通知書(shū)AdmissionLett

12、erAdmissionNoticeofChineseUniversities.□本人最后學(xué)歷成績(jī)單復(fù)印件（須公證，一式兩份）TransoftheMostAdvancedStudies(NotarizedPhotocopy).□本人最后學(xué)歷證書(shū)復(fù)印件（須公證，一式兩份）DiplomaoftheMostAdvancedStudies(NotarizedPhotocopy)：本科Bachel’s□碩士Master’s□博士Doct’s□其它O

13、thers□□外國(guó)人體格檢查記錄（復(fù)印件）FeignerPhysicalExaminationFm(Photocopy).□來(lái)華學(xué)習(xí)計(jì)劃StudyPlaninChina.□所發(fā)表的文章等ArticlesPapersWrittenPublished.□美術(shù)作品（本人作品彩照六張）、音樂(lè)作品（本人音樂(lè)作品盒式錄音帶一盤(pán)）（只限申請(qǐng)美術(shù)和音樂(lè)專(zhuān)業(yè)的申請(qǐng)人）ExamplesofArt(6colpictures)Music(1audiotape)

14、Wk(OnlyftheapplicantsapplyingfFineArtsMusic).□其它附件（請(qǐng)列出）OtherAttachments(ListNeeded)：_______________________________________________________注：每份申請(qǐng)材料最多不超過(guò)20頁(yè)，請(qǐng)全部使用A4紙。Eachsetofthecompletematerialsshouldnotexceed20pages.Ple

15、aseuseDINA4.無(wú)論申請(qǐng)人是否被錄取，上述申請(qǐng)材料恕不退還。Whetherthecidatesareacceptednotalltheapplicationmaterialswillnotbereturned.?申請(qǐng)人保證申請(qǐng)人保證IHerebyAffirmThat:1.申請(qǐng)表中所填寫(xiě)的內(nèi)容和提供的材料真實(shí)無(wú)誤；Allinfmationmaterialsgiveninthisfmaretruecrect.2.在華期間，遵守中國(guó)的

16、法律、法規(guī)，不從事任何危害中國(guó)社會(huì)秩序的、與本人來(lái)華學(xué)習(xí)身份不符合的活動(dòng)；DuringmystayinChinaIshallabidebythelawsdecreesoftheChinesegovernmentwillnotparticipateinanyactivitiesinChinawhicharedeemedtobeadversetothesocialderofChinaareinappropriatetothecapacity

17、asastudent.3.來(lái)華后服從HLJPED所安排的就讀院校和學(xué)習(xí)專(zhuān)業(yè)，不得無(wú)故要求變更學(xué)校和所學(xué)專(zhuān)業(yè)；IwillagreetothearrangementsofmyinstitutionspecialtyofstudyinChinamadebyHLJPEDwillnotapplyfanychangesinthesetwofieldswithoutvalidreasons.4.在學(xué)期間，遵守學(xué)校的校紀(jì)、校規(guī)，全力投入學(xué)習(xí)和研究工作。

18、尊重學(xué)校的教學(xué)安排；DuringmystudyinChinaIshallabidetherulesregulationsofthehostuniversityconcentrateonmystudiesresearchesfollowtheteachingprogramsarrangedbytheuniversity.5.按照規(guī)定參加黑龍江省政府獎(jiǎng)學(xué)金年度評(píng)審；IshallgothroughtheproceduresoftheAnnua

19、lReviewofHeilongjiangGovernmentScholarshipStatusasrequired.6.按規(guī)定期限修完學(xué)業(yè)，按期回國(guó)，不無(wú)故在華滯留；IshallreturntomyhomecountryassoonasIcompletemyscheduledprograminChinawillnotextendmystaywithoutvalidreasons.7.如違反上述保證而受到中國(guó)法律、法規(guī)或校紀(jì)、校規(guī)的懲處

20、，我愿意接受黑龍江省教育廳中止或取消獎(jiǎng)學(xué)金及其它相應(yīng)的處罰。IfIamjudgedbytheChineselawsdecreestherulesregulationsoftheuniversityashavingviolatedanyoftheaboveIwillnotlodgeanyappealagainstthedecisionofHLJPEDonsuspendingwithdrawingmyscholarshipotherpena