外国留学生入学申请表 （语言生）
Application Form for Admission (language programs)       
No. _____________ 
英文姓Family Name on Passport:	英文名Given Names on Passport: 
	
照   片

Photo	
中文姓名 Chinese Name:
	性别 Gender
□男/M □女/F	婚姻状况 Marital Status:
□已婚/Married  □未婚/Single		
出生日期Date of Birth:                       
       年/Yr.       月/Mo.      日/Date         	出生地点Place of Birth:		
国籍Nationality: 	护照号码 Passport No:	护照有效期 Passport Valid Until:
年/Yr.      月/Mo.     日/Date	
签证类型Type of Visa	宗教 Religion	电子邮件E-mail Address:
	
职业Occupation: 	工作或学习单位Employer or School Affiliated:	
海外地址 Address overseas:
街道Street________________________________________________________城市City______________________
国家Country_______________________邮编 Zipcode_____________电话 Phone Number____________________	
邮寄地址（若与上述地址不同） Mailing Address (if different from above)：                      
街道Street________________________________________________________城市City______________________
国家Country________________________邮编 Zipcode_____________电话 Phone Number___________________	
在华事务联系人 Contact person in China：	在华联系人电话 Contact Phone Number：	
申请类别 Applying as:
□ 汉语普通班  Standard Chinese Language Program  □ 商务汉语班 Business Chinese Training Program
□ 汉语强化班  Intensive Chinese Training Program  □ 短期生 Short Term Language Program  (    )周Ｗeeks 
□ 中英双语班  Chinese-English Bilingual Program  □ 一对一辅导 One-on-one Course  (    )小时Hours	
留学期限                             年       月        至       年       月
Enrollment              from          Yr       Mo        to       Yr       Mo	
最后学历 Highest Academic Degree Obtained:	
学习经历 Education Background: (from high school)	
学校名称School/ Institution attended	专业
 Major	开始时间（月/年） From: (mo/yr)	结束时间（月/年） To: (mo/yr)	所获学位Name of qualification	

					
如何了解到华师大?
How did you learn about our programs?

□亲友Relatives or Friends

□网络Internet

□报刊媒体Newspapers_____________

□推荐单位Recommended by an agent ______________

□其他 Other____________	经费来源 Type of Sponsorship:
□自费 Self-supporting 
□外国政府奖学金 Foreign Government Scholarship 
□交流生 Exchange program 
□其他 Other 	
申请人保证：I hereby affirm that:
上述各项中所提供的情况是真实无误的；
All the information given in this form is true and correct;
在中国学习期间将遵守中国政府的法律和学校的规章制度；
I shall abide by the laws of the government of P.R. China and the regulations of the University
申请人签字：                           日期：
Applicant’s signature:                      Date:	
请核对是否已随申请表附上下述材料：
Check that you have attached:
□ 最高学历证书        　　Copies of your academic qualifications
□ 学习成绩单              Copies of transcript related 
□ 护照复印件              Copy of your Passport
□ 报名费400人民币        Application Fee: 400RMB (or 80USD)	
报名费请汇至： Please send the application fee to the following account：
1.帐号名称 (Account Name)： EAST CHINA NORMAL UNIVERSITY
2.帐    号 (Account No.)：   446872907745
3.开户银行 (Bank Name)：    BANK OF CHINA SHANGHAI BRANCH
4. SWIFT号码 (SWIFT Code.): BKCHCNBJ300
5.地    址 (Address):        200 MID YINCHENG ROAD, PUDONG AREA, SHANGHAI,CHINA
6.请注明“报名费”及护照姓名  Please indicate that the payment is for Application Fee and Applicant’s passport name.	

International Students Office
East China Normal University
Room253, Physics Bldg, 3663 Zhongshan Rd (N), Shanghai, China 200062
中国上海中山北路3663号
华东师范大学物理楼236留学生办公室 200062
Tel: +86-21-62233283/62231997; Fax: +86-21-62238352
     E-Mail: lxs@ecnu.edu.cn