黑 龍 江 省 政 府 獎 學 金 申 請 表

1、黑龍江省政府獎學金申請表APPLICATIONFMFHEILONGJIANGGOVERNMENTSCHOLARSHIP請申請人認真閱讀本表第四頁的填表說明。請用中文或英文填寫此表格。請用電腦打印或用藍色或黑色鋼筆認真書寫表格內容。請在所選項框內劃‘X’表示。不按規(guī)定填寫的表格將視作無效。Pleasereadcarefullytheimptantnotesonthelastpagebefefillingoutthefm.Pleasecom

2、pletethefminChineseEnglish.IfthefmisnotfilledinonPCpleasewritelegiblyinblackblueink.Pleaseindicatewith‘X’intheblankchosen.Anyfmsthatdonotfollowthenoteswillbeinvalid.1.申請人情況PersonalInfmation:護照用名PassptName:姓FamilyName:___

3、__________________________________________名GivenName:______________________________________________國籍Nationality:________________護照號碼PassptNo.:_________________出生日期DateofBirth:年Year_______月Month_______日Day_______出生地點Plac

4、eofBirth:國家Country:_____________城市City:_____________男Male：□女Female：□已婚Married：□未婚Single：□其它Other：□母語NativeLanguage:______________________宗教Religion:______________________________________當前聯(lián)系地址PresentAddress:_____________

5、____________________________________________________電話Tel:_____________________傳真Fax:_____________________Email:________________________永久通信地址PermanentAddress:_____________________________________________________________

6、_2.受教育情況EducationBackground:學校在校時間主修專業(yè)畢業(yè)證書及學位證書InstitutionsYearsAttendedFieldsofStudyCertificatesObtained(fromto)ToObtain___________________________________________________________________________________________________

7、______________________________________________________________________________________________________________________________________________________3.工作經歷EmploymentRecd:工作單位起止時間從事工作職務及職稱EmployerTime(fromto)WkEngagedPos

8、tsHeld______________________________________________________________________________________________________________________________________________________________________NO.照片Photo11.申請人是否曾在華學習或任職HaveyoueverStudiedWked

9、inChina是Yes:□學習或任職單位InstitutionEmployer:____________________________________________在華時間TimeinChina:自From:年Year____月Month____至To:年Year____月Month____否No:□12.申請人親屬情況FamilyMembersoftheApplicants:姓名年齡職業(yè)NameAgeEmployment配偶Spo

10、use:_____________________________________________________________________父親Father:_____________________________________________________________________母親Mother:____________________________________________________________

11、_________﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡﹡?所附材料情況所附材料情況（請在所附附件前劃‘X’標明）MaterialsAttached(PleaseIndicatewith‘X’intheBracket.):□申請表（一式兩份）ApplicationFm(induplicate).□兩封推薦信TwoLettersofRecommendation.□有關中國院校接受函或錄取通知書AdmissionLett

12、erAdmissionNoticeofChineseUniversities.□本人最后學歷成績單復印件（須公證，一式兩份）TransoftheMostAdvancedStudies(NotarizedPhotocopy).□本人最后學歷證書復印件（須公證，一式兩份）DiplomaoftheMostAdvancedStudies(NotarizedPhotocopy)：本科Bachel’s□碩士Master’s□博士Doct’s□其它O

13、thers□□外國人體格檢查記錄（復印件）FeignerPhysicalExaminationFm(Photocopy).□來華學習計劃StudyPlaninChina.□所發(fā)表的文章等ArticlesPapersWrittenPublished.□美術作品（本人作品彩照六張）、音樂作品（本人音樂作品盒式錄音帶一盤）（只限申請美術和音樂專業(yè)的申請人）ExamplesofArt(6colpictures)Music(1audiotape)

14、Wk(OnlyftheapplicantsapplyingfFineArtsMusic).□其它附件（請列出）OtherAttachments(ListNeeded)：_______________________________________________________注：每份申請材料最多不超過20頁，請全部使用A4紙。Eachsetofthecompletematerialsshouldnotexceed20pages.Ple

15、aseuseDINA4.無論申請人是否被錄取，上述申請材料恕不退還。Whetherthecidatesareacceptednotalltheapplicationmaterialswillnotbereturned.?申請人保證申請人保證IHerebyAffirmThat:1.申請表中所填寫的內容和提供的材料真實無誤；Allinfmationmaterialsgiveninthisfmaretruecrect.2.在華期間，遵守中國的

16、法律、法規(guī)，不從事任何危害中國社會秩序的、與本人來華學習身份不符合的活動；DuringmystayinChinaIshallabidebythelawsdecreesoftheChinesegovernmentwillnotparticipateinanyactivitiesinChinawhicharedeemedtobeadversetothesocialderofChinaareinappropriatetothecapacity

17、asastudent.3.來華后服從HLJPED所安排的就讀院校和學習專業(yè)，不得無故要求變更學校和所學專業(yè)；IwillagreetothearrangementsofmyinstitutionspecialtyofstudyinChinamadebyHLJPEDwillnotapplyfanychangesinthesetwofieldswithoutvalidreasons.4.在學期間，遵守學校的校紀、校規(guī)，全力投入學習和研究工作。

18、尊重學校的教學安排；DuringmystudyinChinaIshallabidetherulesregulationsofthehostuniversityconcentrateonmystudiesresearchesfollowtheteachingprogramsarrangedbytheuniversity.5.按照規(guī)定參加黑龍江省政府獎學金年度評審；IshallgothroughtheproceduresoftheAnnua

19、lReviewofHeilongjiangGovernmentScholarshipStatusasrequired.6.按規(guī)定期限修完學業(yè)，按期回國，不無故在華滯留；IshallreturntomyhomecountryassoonasIcompletemyscheduledprograminChinawillnotextendmystaywithoutvalidreasons.7.如違反上述保證而受到中國法律、法規(guī)或校紀、校規(guī)的懲處

20、，我愿意接受黑龍江省教育廳中止或取消獎學金及其它相應的處罰。IfIamjudgedbytheChineselawsdecreestherulesregulationsoftheuniversityashavingviolatedanyoftheaboveIwillnotlodgeanyappealagainstthedecisionofHLJPEDonsuspendingwithdrawingmyscholarshipotherpena