Name:

Family Name

Given Names

Nationality:

Passport No.:

Sex:

Marital Status:

Date of Birth:       y.     m.    d.

Place of Birth:

Home Add. and Tel.:

Highest Academic Degree Obtained:

Occupation:

Employer or Institution Affiliated:

Field of study in China:

Duration: from      y.   m. to     y.    m.

Student Status:

Deadline for Registration:

y.       m.     d.

Reference and Tel.:

Guarantor in China and Tel.:

Source of Funding: Scholarship□;  Self-supporting□; Other□

Financial support will be provided by:

Signature of Applicant:

                                               y.     m.    d.