山西医科大学外国留学生入学申请表
SHANXI MEDICAL UNIVERSITY
APPLICATION FORM FOR INTERNATIONAL STUDENTS
1.个人情况Personal statement
英文姓名（以护照用名为准） In English (Same as in your passport) |
姓 Family name |
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名 Given name |
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出生地 Place of birth |
国家 Country |
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城市 City |
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国籍Nationality |
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母语 Native language |
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宗教信仰 Religion |
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性别 Gender |
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婚姻状况 Marital status |
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最后学历 Previous Education |
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年龄 Age |
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出生日期 Date of birth |
____日/ DD______月/ MM _____年/ YYYY |
护照号码 Passport No. |
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有效期至 Valid until |
____日/ DD_____月/ MM _____年/ YYYY |
电话 Tel |
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传真 Fax |
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邮箱 Email |
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目前所在学校或机构 Place of study or work currently |
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职业 Occupation |
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录取通知书邮寄地址 Address for correspondence |
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家庭住址（邮编） Home address（Post code） |
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2.学习情况Study situation
是否学过汉语 Have you studied Chinese? |
是Yes |
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现有汉语水平/Check the appropriate box to indicate the number of Chinese words you know. A None B about 800 C about 1500 D about 2500 E over 3500 |
否 No |
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申请在山西医科大学习的专业 Applied major at SXMU |
Clinical Medicine (MBBS) |
学习时间 Duration of study |
年/year 月/Month 至/to 年/year _月/Month |
学习类别 Study type at SXMU |
语言进修生Chinese Language Students 本科生Undergraduate students |
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3.特长及爱好Special skills or interests
4.教育背景及工作或实习经历 Education background and work or internship experience:
学校 时间（年/月—年/月） Previous and current educational institute years attended (from/to)
工作或实习经历 时间（年/月—年/月） 职务 Employer or place work & internship years attended (from/to) Position
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4.申请人亲属情况Family Members
成员Member |
姓名Name |
年龄Age |
职业Occupation |
联系电话Tel |
邮箱Email |
父亲Father |
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母亲Mother |
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其他共同居住家庭成员Other family members who live with you together(If have any) |
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5.推荐人情况Information for Referees
姓名Name |
工作机构Work organization |
职务Position |
联系电话Tel |
邮箱Email |
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6.在华事务担保人或机构The Guarantor charging your case in China
姓名Name |
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联系电话Tel |
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职业Occupation |
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邮箱Email |
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工作机构 Work organization |
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联系地址 Address |
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7.申请人保证I hereby affirm that
我愿意到山西医科大学学习，并保证： I am willing to study at Shanxi Medical University. I pledge that: （1） 上述各项中所提供的情况真实无误；All the information I provided above is true and correct; （2） 我将遵守中华人民共和国法律；I will abide by the laws of People’s Republic of China. （3） 不从事学习目的以外的活动；I will not engage in activities bearing no relation with my academic pursuit in China. （4） 遵守学校的各项规章制度，努力学习；I will study industriously and observe all rules and regulations of the Unversity. （5） 按时缴纳学校规定的学生应该缴纳的各种费用。I will pay all expenses on time.
日期Date 申请人签字Applicant’s Signature ___________________ |
