1. Passport name Family name: Given name: 2. Nationality Passport No. Photo 3. Date of birth Year Month Day 4. Place of birth Country City 5. Male Female Married Single Other 6. Native language Religion Occupation 7. Permanent address 8. Present address 9. Tel Fax E-mail 10. Language proficiency Chinese Excellent Good Fair Poor None HSK English Excellent Good Fair Poor None IELTS TOEFL Other Language I can be taught in English Yes No 11. Educational background Institutions Years attended Fields of study Certificates obtained (from/to) or to obtain
12. Employment record
Employer Time (from/to) Work engaged Posts held
13. Proposed study plan at Hohai University
Bachelors degree candidate Masters degree candidate Ph.D candidate Chinese language student General scholar Senior scholar Subject or field of study at Hohai University Duration of study from Year Month to Year Month Do you need elementary Chinese study prior to the degree courses Yes from Year_________ Month_________ to Year__________ Month_________ No 14. Special skills or interests
15. Publication
16. Source of financial support: Governmental scholarship University scholarship
Self-supporting Other 17. Family members of the applicant Name Age Employment Spouse Father Mother 18. Information for referees Name Organization Position Email
19. Your guarantor or emergency contact in China
Name Tel Address
20. Organization or person recommending you for this application
Name Tel Address
Your application documents will not be returned despite the admission decision.
I hereby affirm that:
1.All the information given in this form is true and correct. 2.I shall abide by the laws of China and the regulations of the school, and follow the teaching programs arranged by the university.
Applicants signature Date
(The application is invalid without the applicants signature)
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