中国重庆市江北区北滨一路369   邮编:400020

Add: No.369 Beibinyilu Road, Jiangbei District, ChongqingP.R. China  400020

Http//:www.cqjw.gov.cn                                                                                                     (学校填写The above table is only for Chinese higher education institutions)










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.






2 inches Photo

1. 申请人情况/Personal Information

护照用名/Passport Name

/Family Name

/Given Name

国籍/ Nationality                    护照号码/ Passport No.

出生日期/Date of Birth: / Year               / Month          / Day

出生地点/ Place of Birth: 国家/Country              城市/City 

/Male    /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


接收录取通知书地址(包括国家、省州、城市、街道、邮编信息)/Address for receiving admission notice (Street, City, State/Province, Country, Zip code) _____________________________________________________________________________________________



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      /Good      较好/Fair      /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      /Good     较好/Fair      /Poor      不会/None

我的英语水平可以用英语学习/I can be taught in English:    /Yes        /No

c) 其他语言/Other Languages:


5. 来华学习计划/Proposed Study in China

a) 博士研究生/Doctoral Degree Candidate:       硕士研究生/Master’s Degree Candidate:

本科生/Bachelor’s Degree Candidate:         进修生/ Further-study Student: 

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:

   I._____________________________________ II._____________________________ III._____________________________

d) 申请来华专业学习时间/Duration of the Major Study in China:

/From:   /Year            /Month                 /To: /Year             /Month

e) 是否需要补习汉语/Do You Need Elementary Chinese Study Prior to the Major Study?

/Yes:   请填写申请汉语补习时间(不计在专业学习时间)/If “Yes”, please fill in the duration of your elementary Chinese study (not included in the length of the major study ).



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 space is 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. 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:




9. 申请人是否曾在华学习或任职/Have you ever Studied or Worked in China?

/Yes      学习或任职单位/Institution or Employer

在华时间/Time in China: /From: /Year          /Month           /To: /Year            /Month




10. 申请人亲属情况/Family Member of the Applicants:

                姓名 Name                        Age                 职业Employment







所附材料情况(请在所附附件前划“X”标明)/Materials Attached (Please Indicate with “X” in the Bracket.)

      两封副教授或教授推荐信/Two Letters of Recommendation by associate professors or professors.

      有关重庆院校接收函或录取通知书/Admission Letter or Admission Notice of Universities in Chongqing.

      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 Studies (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 Form (Photocopy).

 来华学习计划/ Study Plan in China.

 所发表的文章等/ Articles or Papers Published (Photocopy).

 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 (6 color pictures) and Music (1 audio tape) Work (Only for the applicants applying for Fine Arts and Music).

 其它附件(请列出)/Other Attachments (List Needed)__________________________________________________________


Each set of the complete materials should not exceed 20 pages. Please use DIN A4.


Whether the candidates are accepted or 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 the 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. 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 by the rules and regulations of the host university, concentrate on my study and researches and follow the teaching programs arranged by the university.

4. 按照规定参加重庆市人民政府外国留学生市长奖学金年度评审;

I will go through the procedures of the Annual Review of Chongqing Municipal Government Mayor Scholarship as required.

5. 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.

6. 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.

7. 如违反上述保证而受到中国法律、法规或校纪、校规的惩处,我愿意接受重庆市教育委员会中止或取消奖学金及其它相应的处罚。

If I am judged by the Chinese laws, decrees and the rules and regulations of the university for having violated any of the above, I will not lodge any appeal against the decision of Chongqing Municipal Education Commission on suspending, 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 applicants signature )








版权所有:重庆医科大学 地址:重庆市渝中区医学院路1号 邮政编码:400016