Pingdingshan University
Southern section of Weilai RD of Xincheng District, Pingdingshan, Henan, China. Postcode:467000
Tel: 0086-375-2656211/ 2656233 Fax: 0086-375-2657619
E-mail: pdsxylxs@163.com ; 304159379@qq.com http://www.pdsu.edu.cn/
Application Number (Office Only)
平顶山学院 留 学 申 请 表
APPLICATION FORM FOR STUDY AT PINGDINGSHAN UNIVERSITY
The ＊options are required，the applicant must fill these required options by computers and send it to the above emails.
姓 名 Name |
＊护照姓名（全名） Passport name（Full name） |
照 片 Photo |
中 文 In Chinese |
＊出 生 日 期 （年/月/日） Date of Birth |
＊出 生 地 点 Place of Birth |
＊国 籍 Citizenship |
宗 教 信 仰 Religion |
＊护 照 号 码 Passport No. |
＊护照有效期 （年/月/日） Validity Date of Passport. |
外国人居留许可号码 （如无，写所持签证号码） Residence permit No. (If not, present visa No.) |
居留许可有效期 （年/月/日） Validity date of Residence Permit. (Year/ Month/ Day) |
＊职 业 或 身 份 Occupation or Status |
＊性别 Sex |
＊婚 姻 状 况 Marital Status |
＊电子邮件 E-mail: |
所在大学或工作单位 University or Agency you are now studying or working |
＊永久通讯地址及电话号码 Permanent Address & Telephone Number |
在华通讯地址及电话号码 Present Address & Telephone Number |
＊本 人 学 历 （从高中起） Academic Background (From High School) |
学 校 School |
地 点 Location |
起 止 时 间 Attended from-to |
所 学 专 业 Main Field of Study |
所 获 学 位 Degree |
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本 人 工 作 经 历 Employment Record |
工 作 单 位 Employer |
起 止 时 间 Attended from-to |
从 事 工 作 Work Engaged |
职 务 及 职 称 Posts Held |
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＊计划在平顶山学院学习时间 Planned Duration of Study in Pingdingshan University 从 年 月 日 至 年 月 日 From / / to / / |
＊希望在平顶山学院学习的专业或专题 Specialty or Topic you want to study in Pingdingshan University |
＊学习类别 Categories of Students □汉语进修生 □ 本科生 Chinese Language Student Undergraduate |
申 请 人 亲 属 情 况 Family Member of the Applicants |
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姓 名 Name |
年 龄 Age |
职 业 Occupation |
配 偶 Spouse |
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父 亲 Father |
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母 亲 Mother |
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＊在华学习期间经费来源 Financial Support in China 团体资助/ Organization: □ 家庭资助/ Family: □ 个人支付/ Individual: □ 保证人姓名及地址 Supporter Name & Address 保证人签名（Supporter Signature）: |
推荐人或推荐机构意见 Comment of Sponsor or Recommending Party 机 构 名 称： 签 名： 日 期： Name of Agency Signature Date (Year/ Month/ Date) |
在华事务联系人或机构 Person or Agency to Act on your Behalf in China 联系人姓名（或机构名称） Name (or Name of Agency) 地址及电话 Address & Telephone |
申请人保证：/ I hereby affirm that:
1、 上述各项中所提供的情况是真实无误的；
All the information filled in this form is true and correct;
2、 在中国学习期间遵守中国政府的法律和学校的规章制度；
I shall abide by the law of the Chinese government and regulations of the university;
3、 接受平顶山学院对学习的安排。
I shall accept the arrangements of Pingdingshan University regarding my study.
＊申请人签字 ＊日期：
Applicant Signature Date (Year/ Month/ Day)
注 意：
1、上述所有信息均用电脑输入，以免字迹不清延误审理时间。
2、申请人需核实申请表中所填写个人信息与本人护照一致。
3、申请人应把本人护照和本人毕业证扫描后，发送到pdsxylxs@163.com 或者304159379@qq.com如果毕业证为非英语或汉语，本人需同时提供本人护照、本人毕业证和经权威部门公证过的汉语或英语毕业证。
4、不完整的申请表或未按要求提供有关材料，将会延误对此申请的审理时间。
Notes:
1, all information filled in the Application Form should be typed by means of computers to avoid misunderstanding or mistakes.
2, the applicant should make sure that personal information filled in the Application Form is identical to his or her passport.
3, the applicant should scan your passport and your graduate certificate and send them to pdsxylxs@163.com or 304159379@qq.com. If your original certificate is not English or Chinese version, please ask authorized department or your school to translate it into English or Chinese. And send it with your passport copy and certificate copy to our email together.
4, an incomplete application or the failure to submit supporting documents, WILL DELAY the process of your application.
