西安交通大学第三届丝绸之路医学国际青年学者论坛申请表

1、西安交通大学第三届丝绸之路医学国际青年学者论坛 申请表Ap licati on For The 3rd Silk Road Intern ati onal Symp osium for Dist in guishedYou ng Scholars (SRIS, XJTU Health Scie nee Ce nter, 2017)(非公开信息)(No n-P ublic)、个人基本信息Basic In formatio n姓名Name性别Gen der出生年月Date of Birth专业领域及 方向Area of Exp ertise and ResearchIn terest出生地Plac

2、e of Birth现工作单位Curre nt Empio yer专业技术职务Professi onal Positi on最后学位及 授学位单位Highest Degree Awarded and School of Graduati on国籍Natio nality有效身份证件名称及号码Name and Number of Valid Ide ntificati on通讯地址Address邮政编码Postcode联系电话Tele phone Number固定电话Fixed手机号码Mobile电子信箱Email二、教育经历（从大学填起，按时间顺序正序填写）Educati onal Exp e

3、rie nee (Please p rese nt in chrono logical order, start ing from the bachelor degree)起止年月Start-Due Date院校Un iversity专业Major学位Degree三、工作经历（请按时间顺序正序填写，兼职请注明）Work Exp erie nee (Please p rese nt in chrono logical order and in dicatethe p art-time po siti ons)起止年月Start-Due Date工作单位Empio yer职务/职称Positi o

4、n四、业绩综述（1000字以内）Summary of Academic Performanee (Within 1000 words)五、代表性成果Rep rese ntative Achieveme nt1、代表性论文 (10 篇以内)Rep rese ntative P ublicatio ns (Within 10)作者(按顺序与出全部作者，通讯作者标注*号)；论文名称；发表刊物名称；期号、起止 页码；出版或发表年度Authors (Please p rese nt all authors and mark the corres ponding author with* );Title;

5、Jour nal Name;lssue and Page No.; Year of Publishme nt论文影响力(期刊影响因子，被引用情况，被价情况等)Publicati on Imp act (Jour nal IF, citati on, evaluati on and etc.)2、代表性著作(3 部以内)Representative Works (Within 3)著作名称Book Title出版单位Publisher作者Author出版年度Publicati on Year3、专利(已授权，10项以内)Patents(Granted patents, within 10)专利号

6、Pate nt No.专利名称Pate nt Name类别Type授权国家Country of Granting专利所有者Own er4、获奖（5项以内）Awards（Within 5）获奖或荣誉 名称Name of Award orHo nor颁发机构Issued by获奖等级AwardLevel获奖年份Y ear排名Ranking主要合作者Main Part ner5、主持（参与）的科研项目（10项以内）Projects(leadi ng or p artici pat ing) (Withi n 10)起止时间Start-Due Date项目名称Name经费来源及额度Source and Total Amount of Funding申报人的具体职位 和任务Positi on andRespon sibilities of the App lica nt6、学术组织任职、重要学术报告（10项