研究生交换项目申请表0.doc

Peking University研究生交换项目申请表Application for Graduate Student Exchange Program1. 交换项目信息 Exchange Program Information 项目名称 Program _交换学校 Home University _交换时间 Exchange Duration (dd/mm/yy) _交换层级 Exchange Level 硕士研究生 Master Student 博士研究生 Phd Student 希望在北京大学学习院系及专业 Expected Major at Peking University_经费来源 Source of Funding 奖学金 交换项目 自费 其他 Scholarship Exchange Program Self-Supporting Others贴照片处Photo2. 个人资料 Personal Information姓名 _ _ _ Name Family Name First Name Middle Name出生日期 Date of Birth (dd/mm/yy) _性別 Gender 男 Male 女 Female 婚姻状况 Marital Status 单身Single 已婚Married 国籍/地区 Nationality/Area _护照号及有效期 Passport Number & Date of Expiration _港澳居民往来内地通行证/台湾居民往来大陆通行证号码 Number of the Pass of Hong Kong and Macao /Taiwan Residents for Coming to and Returning from the Mainland of China_通讯地址Mailing Address _E-mail _电话号码 Phone _ 手机号码 Mobile _ 传真号码Fax _紧急情况联系人及电话 Emergency Linkman & Tel _3 教育经历 Education Background 本科教育 Undergraduate Education就读院校 University _就读专业 Major _所获学位 Degree Awarded _研究生教育 Graduate Education当前就读院系Current Institute _年级 Grade _专业 Major _指导教师 Supervisor _预计获得学位 Expected degree _4. 学术发表 Publications_5. 获奖情况 Awards_6. 推荐人 Academic Referees推荐人1 Referee1姓名 _ _ _ 职称 _Name Family Name First Name Middle Name Title工作单位 Service Organization _工作地址 Work Address _电子邮件 Work Email _电话号码 Phone _ 传真号码Fax _推荐人2 Referee2姓名 _ _ _ 职称 _Name Family Name First Name Middle Name Title工作单位 Service Organization _工作地址 Work Address _电子邮件 Work Email _电话号码 Phone _ 传真号码Fax _7. 提交材料确认 (请确认申请交换就读所需材料是否已经提交，复印材料的大小以A4纸为限)(Please affirm the needed material, and the size of the copy should be A4) 简历 Resume 研修计划 Research proposal 学术发表复印件 Photocopy of publications 在学证明 School attendance certificate 护照或身份证复印件 Photocopy of his/her Passport/ID Card 港澳居民往来内地通行证/台湾居民往来大陆通行证复印件 Photocopy of his/her Pass of Hong Kong and Macao /Taiwan Residents for Coming to and Returning from the Mainland of China 研究生成绩单 Academic transcript 两封推荐信 Two letters of recommendation 其它证明材料 Other supporting documents, please specify: _8. 本人声明(1) 上述各项中所提供的信息真实无误。(2) 在北京大学学习期间遵守中国大陆的法规和北京大学的规章制度。(3) 本人已购买意外保险，如在北京大学学习期间出现任何意外，自行负责。I hereby affirm that:(1) All the information I provided above is true and correct.(2) I shall abide by the laws of the Chinese Government and the regulations of Peking University.(3) I had purchased a person-insurance. I will be responsible for myself if there is a thunderbolt to me in Peking University.申请人签名 _ 日期_Signature of Applicant Date9. 派出学校确认 Confirmation of the home university我校同意_参加北京大学研究生交换项目。We confirm _s application for the Graduate Student Exchange Program of Peking University.签名 Signature _职位 Position _日期 Date _ 10