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1、奖学金类别：CIS编号：国家汉办/孔子学院总部HanBan/ Confucius Institute HeadquartersNo.129, Deshengmenwai Street, Xicheng DistrictBeijing P.R. China, Website： 以上仅供孔子学院总部填写 The box above is for Confucius Institute Headquarters孔 子 学 院 奖 学 金 申 请 表APPLICATION FORM FORCONFUCIUS INSTITUTE SCHOLARSHIP矚慫润厲钐瘗睞枥庑赖賃軔。请申请人认真阅读填表说明，
2、用中文或英文填写此表格。Please read the important notes carefully before filling in the form. Please complete the form in Chinese or English. 聞創沟燴鐺險爱氇谴净祸測。照片photograph1. 申请人情况/Personal information：护照用名/Name in passport： 姓/Family name: _（BLOCK LETTERS）残骛楼諍锩瀨濟溆塹籟婭骒。 名/Given name: _（BLOCK LETTERS）酽锕极額閉镇桧猪訣锥顧荭。国籍/N
3、ationality：_ 护照号码/Passport No.：_彈贸摄尔霁毙攬砖卤庑诒尔。出生日期/Date of birth：_年/Year_月/Month_日/Day謀荞抟箧飆鐸怼类蒋薔點鉍。出生地点/Place of birth：国家/Country：_城市/City：_厦礴恳蹒骈時盡继價骚卺癩。男/Male 女/Female已婚/Married 未婚/Single 其它/Other最后学历/Education level：_母语/Nativelanguage：_茕桢广鳓鯡选块网羈泪镀齐。宗教/Religion：_目前所在学校或机构/Place of study or work：_鹅娅尽
4、損鹌惨歷茏鴛賴縈诘。接收录取通知书/奖学金证书地址/Address of receiving acceptance letter or certificate of scholarship：_籟丛妈羥为贍偾蛏练淨槠挞。电话/Tel： _ 传真/Fax：_預頌圣鉉儐歲龈讶骅籴買闥。E-mail：手机/Mobile:永久通信地址/ PermanentAddress：_ 渗釤呛俨匀谔鱉调硯錦鋇絨。_铙誅卧泻噦圣骋贶頂廡缝勵。2. 受教育情况/Education background： 学校 在校期间 主修专业 所获证书擁締凤袜备訊顎轮烂蔷報赢。Institutions From / to Field
5、s of study Diploma/degree obtained贓熱俣阃歲匱阊邺镓騷鯛汉。 _ _ _ _坛摶乡囂忏蒌鍥铃氈淚跻馱。 _ _ _ _蜡變黲癟報伥铉锚鈰赘籜葦。 _ _ _ _買鲷鴯譖昙膚遙闫撷凄届嬌。3. 是否曾在华学习或任职/Have you ever studied or worked in China? 是/Yes 否/No 綾镝鯛駕櫬鹕踪韦辚糴飙钪。如选是/If you Choose Yes, please fill in the following. If more, please attach.驅踬髏彦浃绥譎饴憂锦諑琼。自/From_年/Year_月/Month
6、 至/To：_年/Year_月/Month猫虿驢绘燈鮒诛髅貺庑献鵬。 学习或任职单位/ Institution or Employer: _锹籁饗迳琐筆襖鸥娅薔嗚訝。在华学习的经费来源/Financial Support：_構氽頑黉碩饨荠龈话骛門戲。自费/Own Expense：中国政府奖学金/Chinese Government Scholarship：其他/ Other Source of Funding： 輒峄陽檉簖疖網儂號泶蛴镧。4.语言能力/Language Proficiency: 汉语/Chinese:很好/Excellent：好/Good：较好/Fair：差/Poor：不会/N
7、one：尧侧閆繭絳闕绚勵蜆贅瀝纰。 HSK考试等级或其他类型汉语考试成绩/ Level of HSK test or other certificates which can show your 识饒鎂錕缢灩筧嚌俨淒侬减。Chinese level:_ 凍鈹鋨劳臘锴痫婦胫籴铍賄。英语/English:很好/Excellent：好/Good：较好/Fair：差/Poor：不会/None：恥諤銪灭萦欢煬鞏鹜錦聰櫻。我的英语水平可以用英语学习/I can be taught in English: 是/Yes否/No 鯊腎鑰诎褳鉀沩懼統庫摇饬。其他语言/Other Languages:_ 硕癘鄴颃诌
8、攆檸攜驤蔹鸶胶。5. 来华学习计划/Proposed Study in China: 是否希望参加教师教育或培训/ Do you want to apply for the teacher education/training program？ 是/Yes 否/No 阌擻輳嬪諫迁择楨秘騖輛埙。 申请学习时间/Duration of Study: 自/From: 年/year月/month 至/to:年/year月/month氬嚕躑竄贸恳彈瀘颔澩纷釓。汉语进修生/Chinese Language： 一学期/one semester 一学年/one academic year 釷鹆資贏車贖孙滅獅赘
9、慶獷。汉语国际教育专业硕士/Master of Teaching Chinese to Speakers of Other Languages：怂阐譜鯪迳導嘯畫長凉馴鸨。6.申请院校及专业/Institutions and Majors of Preference in China：谚辞調担鈧谄动禪泻類谨觋。Enter your choices of up to2 in order of preference. Please statewhether you can accept other choices or not.嘰觐詿缧铴嗫偽純铪锩癱恳。第一志愿_专业： 文学类/literature
10、教育学类/Education历史学类/History中医、中药学类/ Traditional Chinese medicine and pharmacy熒绐譏钲鏌觶鷹緇機库圆鍰。第二志愿_专业： 文学类/literature教育学类/Education历史学类/ History中医、中药学类/ Traditional Chinese medicine and pharmacy鶼渍螻偉阅劍鲰腎邏蘞阕簣。是否服从调剂/Can you accept the institutions suggested by theConfucius Institute Headquarters? 是/Yes否/No
11、纣忧蔣氳頑莶驅藥悯骛覲僨。7. 在华事务联系人或机构/Contact of you in China: 名称/Name: _ 电话/Tel: _ 颖刍莖蛺饽亿顿裊赔泷涨负。 传真/Fax：_ E-mail: _濫驂膽閉驟羥闈詔寢賻減栖。地址/Address: _銚銻縵哜鳗鸿锓謎諏涼鏗穎。_挤貼綬电麥结鈺贖哓类芈罷。8. 推荐人/Referee推荐人姓名/Name of Referee: _电话/Tel:_赔荊紳谘侖驟辽輩袜錈極嚕。与申请人关系/ Relationship withApplicant _ 塤礙籟馐决穩賽釙冊庫麩适。推荐意见请另附纸/Recommendations（Please A
12、ttach）申请人保证/ I Hereby Affirm That：本表所填写的内容和提供的材料真实无误；All information and materials given in this form are true and accurate.裊樣祕廬廂颤谚鍘羋蔺递灿。我保证本人身体健康，符合接收院校相关要求，并于来华后提交有效的外国人体格检查记录原件；I promise my health is in good condition and meet the requirements of the acceptanceuniversities and I will submit the o
13、riginal foreigner physical examination form after come to China.仓嫗盤紲嘱珑詁鍬齊驁絛鯛。在华期间，遵守中国法律、法规，不从事任何危害社会秩序的、与本人来华学习身份不相符合的活动；During my stay in China, I shall abide by the laws and decrees of China, and will not participate in any activities which are deemed to be adverse to the social order and are ina
14、ppropriate to my capacity as a student.绽萬璉轆娛閬蛏鬮绾瀧恒蟬。按规定期限离华，不无故在华滞留；I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid reasons.骁顾燁鶚巯瀆蕪領鲡赙骠弒。到华前，我同意自行购买海外保险。在华期间，奖学金之外所产生费用与孔子学院总部及在华就读院校无关； I agree to buy Overseas Insurance
15、 before entering China. During my stay in China, except the scholarship,all other expenses and losses will not be related to the Confucius Institute Headquarters and the University which accepted my studying application in China.瑣钋濺暧惲锟缟馭篩凉貿锕。如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受孔子学院总部的中止或取消奖学金及其他相应处罚；If
16、I am judged by the Chinese laws as having violated any of the above, I will not lodge any appeal against the decision of Confucius Institute Headquarters on suspending, or withdrawing my scholarship, or any other penalties.鎦诗涇艳损楼紲鯗餳類碍穑。如选择汉语国际教育硕士专业，毕业后至少从事2年汉语教学工作。If I choose to study for Master of
17、 Teaching Chinese to Speakers of Other Languages, I shall be committed to Chinese teaching after graduation for at least 2 years.栉缏歐锄棗鈕种鵑瑶锬奧伛。申请人签字/Signature of the Applicant：_ 日期/Date：_辔烨棟剛殓攬瑤丽阄应頁諳。推荐机构名称/RecommendingInstitute_峴扬斕滾澗辐滠兴渙藺诈機。电话/Tel:_传真/Fax:_詩叁撻訥烬忧毀厉鋨骜靈韬。推荐机构负责人签字/Signature of the Referee：_日期/Date：_则鯤愜韋瘓賈晖园栋泷华缙。
