APPLICATION FORM FOR HEILONGJIANG GOVERNMENT SCHOLARSHIP

‘X’

Please read carefully the important notes on the last page before filling out the form. Please complete the form in Chinese or English. If the form is not filled in on PC, 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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/Personal Information:

/Passport Name:

/Family Name: _____________________________________________

/Given Name: ______________________________________________

/Nationality: ________________ /Passport No.: _________________

/Date of Birth: /Year_______/Month_______/Day_______

/Place of Birth: /Country:_____________ /City:_____________

/Male /Female /Married /Single /Other

/Native Language:______________________/Religion:______________________________________

/Present Address:_________________________________________________________________

/Tel: _____________________ /Fax: _____________________ E-mail: ________________________

/Permanent Address: ______________________________________________________________

2. /Education Background:

Institutions Years Attended Fields of Study Certificates Obtained or

(from/to) To Obtain

___________________ _____________________ _____________________ ______________________

3. /Employment Record:

Employer Time (from/to) Work Engaged Posts Held

___________________ _____________________ _____________________ ______________________

4. /Language Proficiency:

a)./Chinese: /Excellent /Good /Fair /Poor /None

HSK / Level of HSK test or other certificates which can show your Chinese level:_________________________________________________________________________

b)./English: /Excellent /Good /Fair /Poor /None

/I can be taught in English: /Yes /No

c)./Other Languages:_______________________________________________________________

5. /Proposed Study in China:

a)./Bachelor’s Degree Candidate

/Master’s Degree Candidate

/Doctor’s Degree Candidate

b)./Subject or Field of Study in China:_______________________________

c)./Preferences of Institutions of Higher Education in China:

.________________________ . ________________________ .__________________________

d)./Duration of the Major Study:

/From/Year_________/Month _________ /To/Year_________/Month ____________

6. / Please Describe the Details of your Study or Research Plan in China (an extra paper can be attached if this space is not enough):

________________________________________________________________________________________

7. /Academic Papers, Writing & Art Works Published:

________________________________________________________________________________________

8. /Scholarship Applied:

A. / Scholarship for undergraduate:

B. / Scholarship for Master Degree:

C. / Scholarship for Doctorate:

9. /Please Specify the Organization or Person Recommending

you for this Scholarship: ___________________________________________________________________

10. /The Guarantor Charging Your Case in China:

/Name:_____________________________ /Tel:_________________ /Fax:_______________/Address:_____________________________________________________________________________

11. /Have you ever Studied or Worked in China?

/Yes: /Institution or Employer: ____________________________________________

/Time in China: /From:/Year____/Month ____/To:/Year____/Month____

/No:

12. /Family Members of the Applicants:

Name Age Employment

/Spouse: __________________________ ______________ _____________________________

/Father : __________________________ ______________ _____________________________

/Mother: __________________________ ______________ _____________________________

l ‘X’/Materials Attached (Please Indicate with‘X’in the Bracket.):

/ Application Form (in duplicate).

/Two Letters of Recommendation.

/Admission Letter or Admission Notice of Chinese Universities.

/Transcripts of the Most Advanced Studies (Notarized Photocopy).

/Diploma of the Most Advanced Studies (Notarized Photocopy)

/Bachelor’s /Master’s /Doctor’s /Others

/ Foreigner Physical Examination Form (Photocopy).

/ Study Plan in China.

/ Articles or Papers Written or Published.

/Examples of Art (6 color pictures) and Music (1 audio tape) Work (Only for the applicants applying for Fine Arts and Music).

/Other Attachments (List Needed)_______________________________________________________

20A4

Each set of the complete materials should not exceed 20 pages. Please use DIN A4.

Whether the candidates are accepted or not, all the application materials will not be returned.

l /I Hereby Affirm That:

All information and materials given in this form are true and correct.

During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate in any activities in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student.

3. HLJPED

I will agree to the arrangements of my institution and specialty of study in China made by HLJPED, and will not apply for any changes in these two fields without valid reasons.

During my study in China, I shall abide the rules and regulations of the host university, and concentrate on my studies and researches, and follow the teaching programs arranged by the university.

I shall go through the procedures of the Annual Review ofHeilongjiang Government Scholarship Status as required.

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.

If I am judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above, I will not lodge any appeal against the decision of HLJPED on suspending, or withdrawing my scholarship, or other penalties.

/Signature of the Applicant:____________________________/Date:___________

/The application is invalid without the applicant’s signature

GUIDELINES FOR FILLING IN THIS FORM (NUMBERS REFERRING TO THE VARIOUS BLOCKS): 1. Personal information about the applicant must be filled in truly and correctly. 2. Please provide the following information for all completed secondary, vocational, technical, undergraduate or post graduate training and qualifications. Any incomplete courses should also be listed. One notarized copy of your official transcripts certificates and notarized copies of English translations of your highest education must be included with each application form. 3. Please clarify your work experiences and you current post. 4. 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. This is very important because it will decide your teaching language in China. 5. HLJPED The applicant will choose the detailed information concerning his study in China according to the clues given in this cell. HLJPED is entitled to make any necessary adjustment according to the applicant’s preferences. a. Please choose what level of study you want to be engaged in in China. b. Please specify your subject or field of study in China. c. HLJPED Please choose three preferences of Chinese institutions among the Chinese universities which can accepted Heilongjiang Government Scholarship students and list them in the blanks here. The final arrangement of institution is subject to the adjustment of HLJPED with your choices as references. If you have been accepted by a Heilongjiang university, please attach the copy of their admission notice to your application materials. d. Duration of the major study applied in China. 6. Please illustrate the subject of your research or the main content of your study, you can also give some courses you want to attend in China. It is crucial for the university to decide your major and arrange the professor for you. 7. Please list here your academic papers, writing and artwork published or written, if any. 8. Choose the Scholarship you applied in the three offered by Heilongjiang Government. 9. The person or organization that recommend you for this scholarship. 10. The guarantors charging your case in China, we will contact them for your case when necessary. 11. If you had ever been to China for study or work, please specify your institution, employer and time in China. 12. General information about the applicant’s family members.