孔 子 学 院 奖 学 金 申 请 表
APPLICATION FORM FOR CONFUCIUS INSTITUTE SCHOLARSHIP
请申请人认真阅读本表第三页的填表说明，用中文或英文填写此表格。请用电脑打印或用蓝色或黑色钢笔认真书写表格内容。请在所选项框内划‘X’表示。不按规定填写的表格将视作无效。
Please read the important notes on the last page carefully before filling out the form. Please complete the form in Chinese or English. If the form is not filled in on the computer, please write legibly in black or blue ink. Please indicate with ‘X’ in the blank chosen. Any forms that do not follow the notes will be invalid.
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1. 申请人情况/Personal information：
护照用名/Name in passport：
姓/Family name: _________________________________（BLOCK LETTERS）
名/Given name: __________________________________（BLOCK LETTERS）
国籍/Nationality：________________ 护照号码/Passport No.：________________
出生日期/Date of birth：____________年/Year________月/Month_______日/Day
出生地点/Place of birth：国家/Country：____________城市/City：___________
男/Male□ 女/Female□ 已婚/Married□ 未婚/Single□ 其它/Other□
最后学历/Education level：_____________母语/Native language：_______________宗教/Religion：___________________
目前所在学校或机构/Place of study or work：_______________________________________________________________
当前联系地址/Current address：___________________________________________________________________________
电话/Tel： __________________________________ 传真/Fax：________________________________________________
E-mail： 手机/Mobile:
永久通信地址/Present Address：__________________________________________________________________________
______________________________________________________________________________________________________
2. 受教育情况/Education background：
学校 在校期间 主修专业 所获证书
Institutions From / to Fields of study Diploma/degree obtained
______________________________ ___________________ ____________________ ____________________
______________________________ ___________________ ____________________ ____________________
______________________________ ___________________ ____________________ ____________________
3. 是否曾在华学习或任职/Have you ever studied or worked in China? 是/Yes □ 否/No □
如选是/If you Choose Yes, please fill in the following. If more, please attach.
自/From________年/Year_________月/Month 至/To：________年/Year_________月/Month
学习或任职单位/ Institution or Employer: _____________________________________________________________
在华学习的经费来源/Financial Support：_____________________________________________________________
自费/Own Expense：□ 中国政府奖学金/Chinese Government Scholarship：□ 其他/ Other Source of Funding： □
4. 语言能力/Language Proficiency:
汉语/Chinese: 很好/Excellent：□ 好/Good：□ 较好/Fair：□ 差/Poor：□ 不会/None：□
HSK 考试等级或其他类型汉语考试成绩/ Level of HSK test or other certificates which can show your
Chinese level:______________________________________________________________________________
英语/English: 很好/Excellent：□ 好/Good：□ 较好/Fair：□ 差/Poor：□ 不会/None：□
我的英语水平可以用英语学习/I can be taught in English: 是/Yes □ 否/No □
其他语言/Other Languages:__________________________________________________________________________
5. 来华学习计划/Proposed Study in China:
是否选择教师教育或培训/ Do you want to apply for the teacher education/training program？ 是/Yes □ 否/No □
申请学习时间/Duration of Study: 自/From: 年/year 月/month 至/to: 年/year 月/month
汉语进修生/Chinese Language Student：： 四周/four weeks □ 一学期/one semester □ 一学年/one academic year □
本科生/Bachelor’s Degree Candidate：□
硕士研究生/Master’s Degree Candidate：□
博士研究生/Doctor’s Degree Candidate：□
6.申请院校/ Institutions of Preference in China：
Enter your choices of up to
A ___________________________________________________________________________________________
B___________________________________________________________________________________________
C___________________________________________________________________________________________
是否服从调剂/Can you accept the institutions suggested by the Confucius Institute Headquarters? 是/Yes□ 否/No□
7. 在华事务联系人或机构/Guarantor in charge of your case in China:
名称/Name: _____________________ 电话/Tel: _________________________________________
传真/Fax：______________________ E-mail: __________________________________________
地址/Address: _____________________________________________________________________________
_________________________________________________________________________________________
8. 推荐人/ Referee
推荐人姓名/Name of Referee: _______________________电话/Tel:________________________________
与申请人关系/ Relationship with Applicant _________________________________________________
推荐意见请另附纸/Recommendations（Please Attach）
申请人保证/ I Hereby Affirm That：
l 本表所填写的内容和提供的材料真实无误；All information and materials given in this form are true and accurate.
l 在华期间，遵守中国法律、法规，不从事任何危害社会秩序的、与本人来华学习身份不相符合的活动；During my stay in China, I shall abide by the laws and decrees of China, and will not participate in any activities which are deemed to be adverse to the social order and are inappropriate to my capacity as a student.
l 按规定期限离华，不无故在华滞留；I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid reasons.
l 到华前，我同意自行购买海外保险。在华期间，奖学金之外所产生费用与孔子学院总部及在华就读院校无关； I agree to buy Overseas Insurance before entering China. During my stay in China, except the scholarship, all other expenses and losses will not be related to the Confucius Institute Headquarters and the University which accepted my studying application in China.
l 如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受孔子学院总部的中止或取消奖学金及其他相应处罚。If I am judged by the Chinese laws as having violated any of the above, I will not lodge any appeal against the decision of Confucius Institute Headquarters on suspending, or withdrawing my scholarship, or any other penalties.
申请人签字/Signature of the Applicant：____________________________________ 日期/Date：________________
派遣单位名称/Recommending Institute__________________________________________________（BLOCK LETTERS）
电话/Tel:__________________________________传真/Fax: ______________________________________________
派遣单位负责人签字/Signature of the Referee：_____________________________________日期/Date：________________
填表说明（每一项数字与申请表中每一项序号相对应）：
GUIDELINES FOR FILLING IN THIS FORM (NUMBERS REFERRING TO THE VARIOUS BLOCKS):
1. 本项所有内容申请人必须如实填写。 Personal information about the applicant must be filled in truthfully and accurately.
2. 请列出申请人已经完成或即将完成的各级教育，包括中学、职业教育及高等教育各项。请随材料附上经公证的最高级教育的学历证明、毕业证书或学位证书的原件复印件和英文翻译件（均一式两份）。
Please provide the following information for all completed secondary, vocational, technical, undergraduate, post graduate training and any other qualifications. One notarized copy of your official transcripts, certificates and notarized copies of your highest education, including their English translations must be included with each application.
3. 请列出申请人曾经从事和现在从事的工作。 Please list your work experiences and you current post.
4. 本项将表明申请人的语言情况，对申请人来华后的课程安排及授课语言非常重要。请随材料附上有关证明材料。
Please state your knowledge of languages, especially Chinese and English. If you have passed a language test, please include a copy of the results in your application materials.
5. 请申请人按本项提示选择来华后的学习计划，孔子学院总部有权作相应调整。
The applicant will choose the details concerning his study in China according to the clues given in this form. However Confucius Institute Headquarters is entitled to make any necessary adjustments according to the applicant’s preferences.
6.请选择三所接受孔子学院奖学金留学生的学校并填写在本栏中，你的选择仅作为安排学校时的参考。如果你已经被某所中国学校录取，请附上该校的《录取通知书》或接受函的复印件。
Please choose three Chinese institutions of preference which can accept the Confucius Institute Scholarship students and list them in the blanks here. The final institution arranged is subject to the adjustment of the Confucius Institute Headquarters with your choices as references. If you have been accepted by a Chinese university, please attach a copy of their admission notice along with your application materials.
7. 在华联系人或联系机构，关于申请人在华的有关事务，我们将与其联系。
With regards to the guarantors in charge of your case in China, we will contacot them on your case whenever necessary.
8. 你的推荐人和推荐机构。The person or organization that recommended you for this scholarship.
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