中国100青年英才培养计划报名表

1、中国100青年英才培养计划报名表姓名性别民族相片出生年月身份证号家庭电话手机E-mail通讯地址邮编就读学校专业（文科/理科）就读年级担任职务现任/曾任校内外社会工作及获奖情况由/至（年/月）活动名称活动规模（国际/国内/跨校/校内）担任职务日期曾荣获的奖项曾获与学业成绩相关的校内、外奖学金（按顺时序列出日期奖学金名称颁发机构志愿者服务或社会服务经验日期服务内容服务时数服务机构组织/参与语言能力（请在相应水平打英语精通良好一般其他（）精通良好一般请撰写一篇名为我对英才的理解及自身与英才目标的比较的短文，字数不超过500字（可另附）申请人认为需要补充的资料：声明书在签署本表格同时，本人确认：1

2、.本表格及随附文件所提供的资料均正确无误，并无缺漏；2 .若成功获选，将承诺全力参与中国100培训计划的学习、考察活动，达到课程要求；3 .若成功获选，将承诺愿意竭尽所能，服务社会；4 .若成功获选，同意自动成为中国100青年英才俱乐部会员，并同意将以上个人资料用作中国100青年英才俱乐部的联络及通讯。申请人签名：年月日就读学校负责人推荐（报名表须交学校填写及盖章）名称负责人姓名负责人职务职称联系方式联络地址邮编负责人对申请人的评价：在签署本表格时，本人确认：1 .以上申请人所填写的校内成绩及校内社会工作资料均正确无误；2 .同意中国100»青年英才培养计划办公室向本人及本校收集本人

3、及受推荐人的资料，以作审核此次报名之用。负责人签名：盖章：年月日年月日一家长意见我同意并支持参加中国100青年英才培养计划所有学习和社会活动。家长签名：年月日China100YouthEliteProjectApplicationFormNameGenderNationPhotoDateofBirthID.CardNo.HomeTel.No.MobileE-mailCorrespondenceAddressZipCodeCurrentSchoolMajor(Arts/Science)GradePost(s)Current/PreviousSocialWorkandPrize(s)Innside

4、andOutsideSchoolFrom/To(yy/mm)NameofActivityScaleofactivity(International/National/Inter-school/Insideschool)Post(s)Date(s)PreviousPrize(s)PreviousAcademic-relatedScholarship(s)/Prize(s)(Inchronologicalorder)Date(s)Scholarship(s)IssuingBody(ies)VoluntaryWorkorCommunityServiceExperienceDate(s)Content

5、ofServicehour(s)ofSenrice(s)NameofOrganisation(s)Organizeorparticipate,LanguageProficiency(markupatTliecorrespondingplace)EnglishExcellenceGoodFairothers()ExcellenceGoodFairPleasewriteanessayofnomorethan500wordsinChineseentitledkMyunderstandingofYouthElite,andmyAdvantageandshortcomingcomparisonwitht

6、heobjectivesofYouthElite".AdditionalInformationofApplicant:DeclarationUponcompletingandsigningthisApplicationForm.IconfirmthatI:5.certifythatalltheinformationprovidedaboveandalltheenclosedsupportingdocumentsarecompleteandaccuratetothebestofmyknowledge;6.shallmakeeveryefforttothechina100Projecta

7、ndReachtheCoursesRequirements,ifsuccessful；7.shallmakeeveryefforttotheservethecommunitywithdevotion,ifsuccessful：8.herebygivemyconsenttobecomeamemberof"China100"YouthEliteProjectandtoreleasemypersonalinformationgivenabovefonifsuccessful;SignatureofApplicant:Date:RecoininendationfromPrincip

8、alofRespectiveSchool(Applicantsshouldsubmittheformtoschoolforcompletionandcertification)NameofSchoolNameofPrincipalPost(s)ofPrincipalTitleTel.No.CorrespondenceAddressZipCodeCommentsonApplicantfromPrincipal:UponcompletingandsigningthisApplicationForm,IconfirmthatI:1 .certifythatalltheinformationtheap

9、plicantprovidedrelatedtoacademicrankandleadershippost(s)atschoolareaccuratetothebestofmyknowledge;2 .givemyconsenttotheSecretariatof"China100"YouthEliteProjecttocarryoutnecessaryreferencecheckandinvestigationwithmyselformyschoolforthepurposeofassessingthisapplication.SignatureofPrincipal:S