辽宁省教育厅
SCHOLARSHIP COUNCIL
LIAONING PROVINCIAL DEPARTMENT OF EDUCATION
中国，辽宁省，**市**区，崇山东路46-1号；
Add:No.46-1 chongshan east road, huanggu district,shenyang
city,liaoning province, P.R. China
邮编：****** post code:110032
电话 Tel ：0086-24-********; 传真 Fax ：0086-24-******** Http//:******
（ The above table is only for
）
请申请人认真阅读本表第四页的填表说明。请用中文或英文填写柴表格。请用电脑打印或用蓝或黑钢笔认真书写表格内容，请在所选项框内划‘X ’表示。不按规定填写的表格将视作无效。
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.
1、 申请人情况 护照用名/Personal Information: 姓/Family Name: 名/Given Name 国籍/ Nationality: 护照号码/ Passport No.
出生日期/Date of Birth：年/ Year 月/ Month 日/ Day
出生地点/ Place of Birth: 国家/Country ： 城市/City ：
男/Male □ 女/Female □ 已婚/Married □ 未婚/Single □ 其它/Other □
母语/Native Language ： 宗教/Religion ：
当前联系地址/ Present Address:
电话/Tel: 传真/Fax : E-mail:
永久通信地址/Permanent Address:
2、受教育情况/Education Background:
学校在校时间主修专业毕业证书及学位证书Institution Years Attended(from/to) Fields of Study Certificates Obtained or To Obtain
3、工作经历/Employment Record:
工作单位起止时间从事工作职务及职称
Employer Time(from/to ) Work Engaged Posts Held
4、语言能力/Language Proficiency)
a) 汉语/Chinese: 很好/Excellent □好/Good □较好/Fair □差/Poor □不会/None □
HKS考试等级或其他类型汉语考试成绩/Level of HKS test or other certificates which can show your Chinese level:
b)英语/English: 很好/Excellent □好/Good □较好/Fair □差/Poor □不会/None □
我的英语水平可以用英语学习/I can be taught in English: 是/Yes □否 /No □
c)其他语言/Other Languages:
5、来华学习计划/Proposed Study in China:
a)本科生/Bachelor’s Degree Candidate: □汉语进修生/Chinese Language Student: □奖学金申请表
硕士研究生/Master’s Degree Candidate: □普通进修生/General Scholar: □
研究学者/Research Scholar: □高级进修生: □
b)申请来华学习专业或研究专题/Subject or Field of Study in China:
c)申请院校/Preferences of Institutions of Higher Education in China:
d)申请专业学习时间/Duration of the Major Study:
自/From: 年/Year 月/Month 至/To: 年/Year /Moth e)是否需要补习汉语/Do You Need Elementary Chinese Study prior to the Major Study?
是/Yes: □请填写申请汉语补习时间（不计在专业学习时间）/If ‘Yes’, please in
duration the duration of your elementary Chinese study (not included in the length of the major study ).
否 /No: □
6、拟在华学习或研究的详细内容（可另附纸）/Please Describe the Details of your Study or
Research Plan in China (an extra paper can be attached if this not enough):
7、曾发表的主要学术论文、著作及作品/Academic Papers, Writing &Art Works Published:
8、推荐您申请中国政府奖学金的机构或个人/Please Specify the Organization or Person
Recommending you for this Scholarship:
9、申请人在华事务联系人或机构/ The Guarantor Charging Your Case in China:
名称/Name: 电话/Tel: 传真/Fax
地址/Address:
10、申请人是否曾在华学习或任职/Have you ever Studied or Worked in China?
是/Yes □学习或任职单位/Institution or Employer
在华时间/Time in China: 自/From: 年/Yeas 月/Moth 至/To: 年/Year 月/Moth
否/No □
11、申请人亲属情况/Family Member of the Applicants:
姓名年龄职业
Name Age Employment
配偶/Spouse:
父亲/Father:
母亲/Mother:
********************************************
****
◆所附材料情况（请在所附附件前‘X’标明）/materials attached (Please Indicate with
‘X’in the Bracket.):
□两封推荐信/Two Letter of Recommendation.
□有关中国院校接受函或录取通知书/Admission Letter or Admission Notice of China
Universities.
□本人最后学历成绩单复印件（须公证）/Transcripts of the Most Advanced studies （Notarized photocopy ）
□本人最后学历证书复印件（须公证）/Diploma of the Most Advanced Studied(Notarized
photocopy)
□本科/Bachelor’s 硕士/Master’s 博士/Doctor’s 其它/Others
□外国人体格检查记录（复印件）Foreigner physical Examination From (photocopy)
□来华学习计划/study Plan in China
□所发表的文章等/Article or Papers writer or published
□美术作品（本人作品彩照六张）、音乐作品（本人音乐作品盒式录音带一盘）（只限申请美术和音
乐专业的申请人）/Examples of Art (6color pictures )and Music (I audio tape) Work (Only
for the applicants applying for Fine Arts and Music)
□其它附件（请列出）/Other Attachments(List tape):
注：每份申请材料最多不超过20页，请全部用A4纸
Each set of the complete materials should not exceed 20 pages .Please use DIN A4.
无论申请人是否被录取，上述申请材料恕不退还。
Whether the candidates are accepted o r not , all the application materials will not be returned.
申请人保证/I Hereby Affirm That: .
1．申请表中所填写的内容和提供的材料真实无误：
All information and materials given in this form are true and correct
2．在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动；During my stay in China, I shall abide by the laws and decrees of the Chinese
government, and will not participate in 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. 来华后服从辽宁省教育厅所安排的就读院校和学习专业，不得无故要求变更学校和所学专业；
I will agree to the arrangement of my institution and specialty of study in China made by Liaoning Provincial Department of Education, and will not apply for any changes in these two fields without valid reasons.
4.在学期间，遵守学校的校纪、校规，全力投入学习和研究工作。尊重学校的教学安排；
During my study in China, I shall abide the rules and regulations of the host university, and concentrate on my study and researches, and follow the teaching programs arranged by the university.
5.按照规定参加辽宁省政府奖学金年度评审；
I will go through the procedures of the Annual Review of Liaoning Provincial Government Scholarship as required.
6.按规定期限修完学业，按期回国，不无故在华滞留；
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.
7.我保证，未同时接受其它任何渠道的奖学金或资助。
I declare that this is the only Scholarship I am applying for at present.
8.如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受辽宁省教育厅中止或取
消奖学金及其它相应的处罚。
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 Lingning Provincial Department of Education on suspending, or withdrawing, or other penalties.
申请人签字/Signature of Applicant: 日期/Date: (无此签名，申请无效/The application is invalid without the applicant’s signature )
填表说明（每一项数字与申请表中每一项序号相对应）：
GUIDELINES FOR FILLING IN THIS FORM(NUMBERS REFERRING TO THE VARIOUS BLOCKS):
1、本项所有内容申请人必须如实填写。
Personal information about the applicant must be filled in truly and correctly.
2、请列出申请人已经完成或即将完成的各级教育，包括中学、职业教育及高等教育各项。请材料
附上经公证的最高级教育的学历证明、毕业证书的原件复印件和英文翻译件。
Please provide the following information for all complete secondary , vocational, technical, undergraduate or post graduate training and qualifications. Any incomplete courses should also be listed. One notarized copy of your official transcripts
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