脊 柱 Spine |
척추 |
四 肢 Extremities |
사지 |
神经系统 Nervous system |
신경계통 | ||||
其它所见 Other abnormal findings |
기타 소견 | ||||||||
胸部X线 检查结果 (附检查报告单) Chest X-ray Exam (attached chest X-ray report) |
흉부 X선 검사 결과 (임상진찰보고서첨부) 즉, X-레이 필름을 첨부 |
心电图 ECG |
심전도 | ||||||
化验室检查 (包括艾滋病、梅毒等血清学检查) Laboratory exam (Attached test report of AIDS, Syphilis etc)
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화학검사 에이즈 매독 등 혈청학 검사 | ||||||||
未发现患有下列检疫传染病和危害公共健康的疾病: 미발견된 아래 검역 전염병과 해로운 공공건강 질병 None of the following diseases of disorders found during the present examination. 霍 乱 Cholera 콜레라 性 病 Venereal Disease 성병 黄热病 Yellow fever 황열병 肺结核 Lung tuberculosis 폐결핵 鼠 疫 Plague 페스트 艾滋病 AIDS 에이즈 麻 风 Leprosy 천연두 精神病 Psychosis 정신병
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意 见 의견 检查单位盖章 검사기관 날인 Suggestion Official Stamp
医师签字 의사 서명 日期 날짜 Signature of physician Date
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The foreigners are supposed to take the physical examination before leaving in a national or regional public hospital and get report of all the items listed in the from with the signature of the doctor and the stamp of the hospital. If the check is done in a private hospital or clinic, the report should be notarized by a public notary. The form submitted should be the original copy with the photo of the examinee and supporting documentations such as laboratory report sheets, X-ray films and necessary testing reports.
The Administration of Quality supervision, Inspection and Quarantine will double check the submitted form and attached documentations upon their arrival and decide whether it's acceptable or they should take additional or another physical examination. If additional check or re-check is required, the student should follow the requirement and pay for their own. The double check fee is RMB 60.00 yuan which should be covered by the students themselves.
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申请号(办公室填写)
Application No. (Office Only)
扬 州 大 学 留 学 申 请 表
APPLICATION FORM FOR STUDY AT YANGZHOU UNIVERSITY
姓名 Name |
英文 In English First Name / Middle Name / Family Name |
照 片 Photo
2寸 2 Inch | |
中文: 性别: □男 □女 In Chinese Gender Male Female | |||
国籍: 出生日期:__年 _月 _日 出生地点: Nationality Date of Birth yy / mm / dd Place of Birth | |||
护照号码: 颁发国家: 有效期:__年 _月 _日 Passport No. Country of Issue Valid Till yy / mm / dd | |||
□居留许可/□签证号码: 颁发日期:__年 _月 _日 有效期:__年 _月 _日 No. of □Residence Permit □Visa Date of Issue yy / mm / dd Valid Till yy / mm / dd | |||
职业/身份: 宗教信仰: 婚姻状况: Occupation / Status Religion Marital Status | |||
所在工作单位或学校: Current Employer or Institution Affiliated | |||
永久家庭地址: Permanent Home Address 家庭电话: Permanent Home Phone | |||
通讯地址: Address for Correspondence 联系电话: 传真: 手机: Phone for Contact Fax Mobile Phone | |||
电子邮件 E-mail: @ | |||
计划在扬州大学学习时间 Planned Duration of Study in Yangzhou University: 自 ____年 __月 __日 至 ____年 __月 __日 From yyyy / mm / dd to yyyy / mm / dd | |||
学习类别 Student Status: □ 语言生 □ 普通进修生 □ 高级进修生 □ 研究学者 Language Student General Scholar Senior Scholar Research Scholar □ 博士研究生 □ 硕士研究生 □ 本科生 □ 预科生 Doctoral Student Master’s Student Undergraduate Student Preparatory Student
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希望在扬州大学学习的专业或专题(请按志愿排序): 是否服从分配? □是Yes □否No Program you want to attend in Yangzhou University Do you agree to follow our advise ( You can list two choices according to your preference ) 1. 2. | |||
在华学习期间经费来源 Source of Funding: □ 自费 □ 校际交流项目(请具体说明) Self-Support University Exchange Program (Please Specify) □ 奖学金(请具体说明) Scholarship (Please Specify) | |||
在华事务联系人/机构Person/Agency to Act on your Behalf in China: 姓名/名称Name 地址Address 电话Phone 传真Fax 手机Mobile | |||
本人学历(从高中起)Education Background(From High School) : 学校名称 起止时间 所学专业 所获学位 Name of School From/To Major/Field of Study Degree
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本人工作经历 Working Experience: 工作单位 起止时间 从事工作 职务/职称 Employer From/To Responsibility Position/Title
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申请人亲属情况Family Members: 姓名 年龄 职业 Name Age Occupation 配偶 Spouse 父亲 Father 母亲 Mother 子/女Son/Daughter 子/女Son/Daughter | |||
本人特长与爱好Skills and Hobbies:
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你是否参加过汉语水平考试?Have you ever taken the HSK test? □是Yes □否No 如果是,请按以下格式列出考试信息,并在申请表后附上HSK证书及成绩单。 If yes, please list information below, and attach the HSK Grade & Scores to this Application Form. 考试时间 Date 总分 Total Scores 级别Grade 听力 Listening 语法Grammar 阅读Reading 综合Comprehensive 如果否,请回答下列问题 If no, please answer the following questions: 1. 你学习过汉语吗?Have you learned Chinese? □是Yes □否No 2. 你学习汉语多久了?How long did you study Chinese? □1年以下 □1-2年 □2-3年 □3年以上(请说明: 年,从 年 月到 年 月) Less than 1-Y 1-2 Years 2-3 Years more than 3-Y Years from yy / mm to yy / mm 3. 你学习汉语的方式?How did you study Chinese? □在中文学校学习 □在大学学习 □自学 □在中国学习(学校名称: ) Chinese School University Course Self-Study In China Name of University 4. 你现在的汉语水平如何?How do you think of your Chinese ability? 听 □很好 □还行 □懂一点 □不行 说 □很好 □还行 □懂一点 □不行 Listen Good Not Bad A Little Awful Speak Good Not Bad A Little Awful 读 □很好 □还行 □懂一点 □不行 写 □很好 □还行 □懂一点 □不行 Read Good Not Bad A Little Awful Write Good Not Bad A Little Awful | ||
请注意:下列材料是本申请表的必要附件!
Please note that the following documents are COMPULSORY attachments to this Application Form!
① 最后学历证明书 Highest Academic Diploma
② 学习成绩单 Transcript of Academic Record
③ 一封推荐信 A letter of Recommendation
⑤ 护照复印件 A copy of Passport
⑥ 护照规格照片8张 8 Passport-Size Photos
⑦ 担保书 Guarantee Statement
特别提醒:申请表填写错漏或必要附件缺失都将影响申请的审批进度!
Attention: Incorrect or incomplete submission of information or attachment will delay the process of your application!
申请人保证:
I hereby affirm that
1. 上述各项中所提供的信息真实无误;
All the information filled in this Application Form is true and correct
2. 在中国学习期间遵守中国的法律和学校的规章制度;
I shall abide by the Chinese law and the University regulations
3. 接受扬州大学的管理。
I shall submit to the supervision of Yangzhou University
申请人签字: 递交日期:
Signature of Applicant Date of Submission(yyyy/mm/dd)
请将完整填写的申请表和附件寄往:
Please send the completed Application Form with required attachments to
225009 中华人民共和国江苏省扬州市大学南路88号 扬州大学海外教育学院
College for Overseas Education, Yangzhou University, 88 South University Road, Yangzhou, Jiangsu 225009, P.R.China
传真请洽:0086-514-8797-1276(FAX) 电邮请洽:coe@yzu.edu.cn(EMAIL)
Application through fax / email is also acceptable. Please contact the above number / address.
担 保 书 보증서
Guarantee Statement
申请入学者姓名 입학신청자 이름
Applicant’s Name
国籍 국적 性别 성별
Citizenship Sex
我愿意做以上申请人在中国扬州大学学习期间的担保人。如该学生在扬州大学学习期间出现任何意外和经济问题,我将负全部责任。特此声明!
I hereby guarantee to be responsible to the above applicant’s behavior and finance during the period of his/her study in Yangzhou University, China. Should there be any emergency or financial problem occurred to him/her, I will be in duty bound to take my responsibility for it.
※ 以下由担保人填写 ※ 이하 보증인 기록
The following items should be filled by the Guarantor in person.
姓名 이름 国籍 국적
Name of Guarantor Citizenship of Guarantor
与被担保人关系(관계): □父亲 □母亲 □夫妻 □亲戚 □推荐机构 □朋友
□아빠 □엄마 □부부 □친척 □추천기관 □친구
Relation with Applicant father mother spouse relative agency friend
电话 전화 传真 팩스
Phone Fax
手机 휴대전화 电邮 이메일
Mobile Phone Email
通讯地址 주소
Address for Correspondence
签名 서명 日期 날짜
Signature of Guarantor Date of Signature
外 国 人 体 格 检 查 表
FOREIGNER PHYSICAL EXAMINATION FORM
姓名 Name |
이름 |
性别 Sex |
□男 Male □女 Female |
出生日期 Birth Day – Month - Year |
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照 片 (加盖检查 单位印章) 사진 Photo (stamped Official stamp) | ||||
现在通信地址 Present mailing address |
현주소 |
血型 Blood Type 혈액형 | ||||||||
国籍或地区 Nationality (or Area) |
국적 |
出生地址 Birth Place |
출생지 | |||||||
过去是否患有下列疾病:(每项后面请回答“否”或“是”) 아래와 같은 병이 있나요? (무조건 없다고 표시) Have you ever had any of the following deseases? (Each item must be answered “Yes” or “No”) 斑 疹 伤 寒 Typhus fever □No□Yes 菌 痢 Bacillary dysentery □No□Yes 발진티프스 세균성 이질 小儿麻痹症 Poliomyelitis □No□Yes 布氏杆菌病 Brucellosis □No□Yes 소아마비 브루셀라증 파상열병 白 喉 Diphtheria □No□Yes 病毒性肝炎 Viral hepatitis □No□Yes 디프테리아 바이러스성 간염 猩 红 热 Scarlet fever □No□Yes 产褥期链球 Puerperal streptococcus infection 성홍열 산후 감염질환 回 归 热 Relapsing fever □No□Yes 菌 感 染 □No□Yes 회귀열 세균감염 伤寒和付伤寒 Typhoid and paratyphoid fever □No□Yes 동상 流行性脑脊髓膜炎 Epidemic cerebrospinal meningitis □No□Yes 유행성 뇌수막염
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是否患有下列危机公共秩序和安全的病症:(每项后面请回答“否”或“是”) Do you have any of the following diseases or disorders endangering the public order and security? (Each item must be answered “Yes” of “No”) 毒物瘾 Toxicomania …………………………………………마약중독………………… □No□Yes 精神错乱 Metal confusion …………………………………정신착란………………… □No□Yes 精神病 Psychosis:躁狂型 Manic Paychosis ………… ……간질…………………□No□Yes 정신병 妄想型 Paranoid psychosis ………………………망상증……… □No□Yes 幻想型 Hallucinatory psychosis ……………………몽유병……… □No□Yes
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身高 키 厘米 Height CM |
体重 체중 公斤 Weight kg |
血压 혈압 毫米汞柱 Blood pressure mmHg | ||||||||
发育情况 발육상태 Development |
营养情况 영양상태 Nourishment |
颈部 목 Neck | ||||||||
视力 시력 左L________ Vision 右R |
矫正视力교정시력 左L_______ Corrected vision 右R |
眼 눈 Eyes | ||||||||
辨色力 색맹 Colour senses |
皮肤 피부 Skin |
淋巴结 임파절 (림프) Lymph nodes | ||||||||
耳 귀 Ears |
鼻 코 Nose |
扁桃体 편도선 Tonsils | ||||||||
心 심장 Heart |
肺 폐 Lungs |
腹部 복부 Abdomen | ||||||||
脊 柱 Spine |
척추 |
四 肢 Extremities |
사지 |
神经系统 Nervous system |
신경계통 | ||||
其它所见 Other abnormal findings |
기타 소견 | ||||||||
胸部X线 检查结果 (附检查报告单) Chest X-ray Exam (attached chest X-ray report) |
흉부 X선 검사 결과 (임상진찰보고서첨부) 즉, X-레이 필름을 첨부 |
心电图 ECG |
심전도 | ||||||
化验室检查 (包括艾滋病、梅毒等血清学检查) Laboratory exam (Attached test report of AIDS, Syphilis etc)
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화학검사 에이즈 매독 등 혈청학 검사 | ||||||||
未发现患有下列检疫传染病和危害公共健康的疾病: 미발견된 아래 검역 전염병과 해로운 공공건강 질병 None of the following diseases of disorders found during the present examination. 霍 乱 Cholera 콜레라 性 病 Venereal Disease 성병 黄热病 Yellow fever 황열병 肺结核 Lung tuberculosis 폐결핵 鼠 疫 Plague 페스트 艾滋病 AIDS 에이즈 麻 风 Leprosy 천연두 精神病 Psychosis 정신병
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意 见 의견 检查单位盖章 검사기관 날인 Suggestion Official Stamp
医师签字 의사 서명 日期 날짜 Signature of physician Date
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The foreigners are supposed to take the physical examination before leaving in a national or regional public hospital and get report of all the items listed in the from with the signature of the doctor and the stamp of the hospital. If the check is done in a private hospital or clinic, the report should be notarized by a public notary. The form submitted should be the original copy with the photo of the examinee and supporting documentations such as laboratory report sheets, X-ray films and necessary testing reports.
The Administration of Quality supervision, Inspection and Quarantine will double check the submitted form and attached documentations upon their arrival and decide whether it's acceptable or they should take additional or another physical examination. If additional check or re-check is required, the student should follow the requirement and pay for their own. The double check fee is RMB 60.00 yuan which should be covered by the students themselves.