湖北省教育厅 HUBEIPROVINCIAL DEPARTMENT OF EDUCATION 表二
中国 湖北省武汉市武昌区洪山路8号 430071
8 HONGSHAN ROAD WUHAN，HUBEI，P.R.China430071
Tel: 0086-27-87328141 E-mail: fao@e21.edu.cn
Fax:0086-27-87328047Http://www.hbe.gov.cn/
湖北省外国留学生奖学金申请表
APPLICATIONFORM FOR
HUBEI
PROVINCIAL INTERNATIONAL STUDENT SCHOLARSHIP
(此表供已在申请学校就读的申请人使用 Applicable for applicants being admitted to universities in Hubei)
请用中文或英文填写此表格。请用电脑打印或用蓝色或黑色钢笔认真书写表格内容。请在所选项框内划‘X’表示。不按规定填写的表格将视作无效。Please complete theform in Chinese or English. If the form is not filled in on PC, please writelegibly in black or blue ink. Please indicate with‘X’in the blank chosen. Anyforms that do not follow the notes will be invalid.
1. 申请人情况/PersonalInformation:
护照用名/Passport Name:
姓/Family Name: _______________________ 名/Given Name: __________________________
国籍/Nationality: __________________ 护照号码/Passport No.:______________________
出生日期/Date of Birth: 年/Year___________月/Month___________日/Day______________
出生地点/Place of Birth: 国家/Country:_________________城市/City:_______________
男/Male□ 女/Female□ 已婚/Married□未婚/Single□ 其它/Other□
母语/Native Language:__________________________ 宗教/Religion:___________________
当前联系地址
/Present Address:________________________________________________________________
电话/Tel: _______________ 传真/Fax: _______________ E-mail: ______________________
永久通信地址
/Permanent Address:_____________________________________________________________
2. 受教育情况/Education Background:
学校Institutions 在校时间Years Attended(from/to) 主修专业Fieldsof Study
_____________________________________________________ ________________________
_____________________________________________________ ________________________
_____________________________________________________ ________________________
_____________________________________________________ ________________________
最后学历及学位/Most Advanced Studies：
博士/Doctor’s□ 硕士/Master’s□ 本科/Bachelor’s□ 高中r’s□
3. 工作经历/Employment Record:
工作单位Employer 起止时间Time (from/to) 从事工作Work Engaged 职务及职称Posts Held
_____________________________________ ___________________ ____________________
_____________________________________ ___________________ ____________________
___________________ _____________________________________ ____________________
_____________________________________ ___________________ ____________________
4. 语言能力/Language Proficiency:
a).汉语/Chinese:很好/Excellent□好/Good□ 较好/Fair□ 差/Poor□ 不会/None□
b).英语/English:很好/Excellent□好/Good□ 较好/Fair□ 差/Poor□ 不会/None□
c).其他语言/OtherLanguages:____________________________________________
5. 来华学习计划/Proposed Study in China:
a).本科生/Bachelor’s Degree Candidate：□ 语言进修生/Language Student：□
硕士研究生/Master’s DegreeCandidate：□ 普通进修生/General Scholar：□
博士研究生/Doctor’s DegreeCandidate：□ 高级进修生/Senior Scholar：□
b).申请来华学习专业或研究专题/Subject or Field of Study inChina:
______________________________________________________________________________
______________________________________________________________________________
c).申请专业学习时间/Duration of the Major Study:
自/From：年/Year________月/Month________至/To：年/Year_________月/Month________
6.申请人亲属情况/Family Members of the Applicants:
申请人亲属情况/Family Members ofthe Applicants:
姓名 年龄 职业/Name AgeEmployment
配偶/Spouse:__________________________ __________ ____________________
父亲/Father:__________________________ __________ ____________________
母亲/Mother:__________________________ __________ ____________________
7.所附材料情况/MaterialsAttached:
□ 申请表（一式两份）/Two Letters of Recommendation.
□ 在校学习成绩单复印件（须学校教务盖章）/Transcripts of the Most Advanced Studies (Notarized Photocopy).
□ 最后学历证书复印件（须公证）/Diploma of the Most Advanced Studies (Notarized Photocopy)：
□ 体格检查记录（复印件）/ Foreigner Physical Examination Form (Photocopy).
□ 其它附件（请列出）/Other Attachments (List Needed)：
8.申请人保证/I Hereby Affirm That:
a)申请表中所填写的内容和提供的材料真实无误；All information andmaterials given in this form are true and correct.
b)在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动；During my stay in
China
,I shall abide by the laws and decrees of the Chinese government, and will notparticipate in any activities in
China
which are deemed to be adverse to the social order of
China
and areinappropriate to the capacity as a student.
c)在学期间，尊重学校的教学安排，遵守学校的校纪、校规，全力投入学习和研究工作；Duringmy study in
China
,I shall abide the rules and regulations of the host university, and concentrateon my studies and researches, and follow the teaching programs arranged by theuniversity.
f)按照规定参加奖学金年度评审；I shall go through theprocedures of the Annual Review of Scholarship Status as required.
g)如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受中止或取消奖学金及其它相应的处罚。If I am judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above, Iwill not lodge any appeal against the decision on suspending, or withdrawing myscholarship, or other penalties.
申请人签字/Signature of theApplicant:
__________________________________________日期/Date: _________________________
（无此签名，申请无效/Theapplication is invalid without the applicant’s signature）
﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡ ﹡(以下由所在院校填写)
外国留学生所在院校名称：_________________________________
外国留学生入学渠道:政府奖学金□ 校际交流□ 自费学习□
单位或个人推荐□其他途径/Other□
来华时间：______________年______________月______________日
入校时间：______________年______________月______________日
在校期间所获总学分：_______________ 各门课程成绩平均分：_____________
发表的主要学术论文、著作及作品：
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
参加的主要社会实践活动：
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
导师或班主任评语及意见：
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
签字 年 月 日
所在学校评审意见：
________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
负责人签字 （公章） 年 月 日
