护照姓名

Name in Passport

姓

Surname

名

Given Name

照片

Photo

(Required， otherwise invalid)

中文姓名

Chinese Name

男Male     □

女Female   □

未婚Single     □

已婚Married    □

护照号码

Passport Number

护照有效期

Date of Expiry

    年Y    月M    日D

出生地点Place of Birth

国籍/Nationality

出生日期Date of Birth

   年/Y  月/M   日/D

职 业/Occupation

宗教信仰/Religion

通信地址（邮寄录取通知书和JW202表）Post Address for Acceptance Letter and JW202

电话Tel:

电子邮件E-mail:

本人最后学历Final Education Background

自Fr       至To

高中

Senior High School

自Fr       至To

大学

College or University

留学类别

Type of Program

•    1、攻读学位Degree Program        大专Undergraduate

•    2、不读学位Non-Degree Program    汉语语言生Chinese Language

学习或研究专业Major of Study or Research

□汉语Chinese     □其他Other：______           

期限Duration of Study or Research

自From     年Y     月M 至To    年Y    月M

在华事务联系人和电话

Emergency Contact in China & Tel.

推荐单位和电话 Recommended by & Tel.

语言能力

Language Proficiency

母语Native Language

汉语水平Chinese Proficiency

其他语言Other Language

□入门Beginner     □初级Primary  

□中级Intermediate  □高级Advanced

申请人保证I hereby affirm that

1) 上述各项中填写的信息和提供的材料真实无误；All the information and materials provided are true and correct.

2) 在华期间，遵守中国的法律和法规；During my stay in China, I shall abide by the laws and decrees of China.

3) 在铜仁职业技术学院学习期间，遵守学校各项规章制度。During my study in TPC, I shall abide by the rules and regulations of the university.

申请人签字/ Applicant signature(It has to be signed)                             

  (      无此签名，申请无效/The application is invalid without the applicant’s signature)

SIGNATURE:

                                                    日期/Date:        年Y       月M       日D

备 注

Remarks

1、请用英语或中文填写 Please complete the form in English or in Chinese.

2、请保证字迹工整 All information should be clear and neat in print.