北京大學醫(yī)學部外國留學生進修生入學申請表

1、北京大學醫(yī)學部外國留學生進修生入學申請表APPLICATION FORM FOR ADVANCED STUDENT姓 名Name(Please type or print)外文 First name / Middle name / Family name相片Photo中文In Chinese性別Sex國籍Citizenship婚姻狀況Marital Status護照號碼Passport No.有效期至 年 月Valid Until Year Month出生日期 年 月 日Date of Birth Year Month Date出生地點Place of Birth最后學歷Highest Edu

2、cation Level宗教信仰Religion所在大學或部門University or Place of Work職業(yè)或身份Occupation or Status目前聯(lián)系地址及電話 Current Mailing Address & Tel:( Please type or print)E-mail:永久通訊地址及電話 Permanent Mailing Address & Tel:( Please type or print)本人簡歷Personal Background年、月至年、月Duration學?；蚬ぷ鲉挝籒ame of High School/Universit

3、y/Employer做何事Position/Student Status請選擇所學專業(yè) 臨床醫(yī)學 口腔醫(yī)學 備注：_Please choose your major要求何時入學 Proposed study duration in university是否學過漢語？達到何種程度？Have you ever learnt Chinese and at which level? 很好 一般 不會Good Learnt Nil學習或研究計劃Study or project plan在華事務(wù)擔保人姓名 Name of Sponsor in China 推薦單位 Institution or Compa

4、ny 通訊地址/Mailing Address聯(lián)系電話/Tel 經(jīng)濟擔保人姓名 Name of Financial Guarantor 職業(yè) Occupation 通訊地址/Mailing Address聯(lián)系電話/Tel 申請人保證：上述各項中所提供的情況是真實無誤的；在校學習期間遵守中國政府的法規(guī)和學校的規(guī)章和制度；遵守學校的規(guī)定交納各項費用。I hereby affirm that:All the information I provided above is true and correct;I shall abide by the laws of the Chinese Governm

5、ent and the regulations of Peking University;I will pay the fees as outlined in the regulation.申請人簽字/Signature: 日期/Date:注：申請人在遞交此申請表的同時，須提交申請費人民幣800元Remarks: The applicant is required to summit the application fee RMB￥800 with this form.學校意見（此欄由學校填寫）/ Comment (Office use only)郵寄地址: Mailing Address:郵政編碼 100083 Foreign Student Office中國北京市海淀區(qū)學院路38號 Peking University Health Science Center北京大學醫(yī)學部留學生辦公室 Beijing 100083, China電話:86-10-