留学入学申请书(3)

application form for foreigners wishing to study at fudan

申请人认真阅读本表末页的注意事项后再填写下列诸项：

please read the important notes at the end of the form carefully before filling in the form

1.申请人简况/personal information

姓/family name________________________ 名/given name________________________

中文名/chinese name______________ 国籍/nationality___________性别/sex____________

出生年月/date of birth:___________年/year______月/month______日/day

出生地点/place of birth___________________ 婚姻状况/marital state___________________

护照号码/passport no____________________ 宗教信仰/religion_______________________

现职业和工作单位/current employment & employer

_____________________________________________________________________________

联系地址/present address ________________________________________________________

邮编/zip code_____________________________电话/tel_______________________________

传真/fax_________________________________ e-mail________________________________

2.受教育情况/educational background

学校institutions _______________________________________________________________

在校时间year attended(from/to) __________________________________________________

主修专业fields of study ________________________________________________________

所获文凭diploma received ______________________________________________________

3.语言能力/language proficiency

汉语chinese: ______________________________

英语english:_______________________________

其他 others:_______________________________

4.来复旦学习计划/plan of study in china (please click what you plan to study)

1)语言生/language student □ 普通进修生/general advanced student □

高级进修生/senior student □ 本科生/bachelor's degree □

硕士研究生/master's degree □ 博士研究生/doctorate □

2)专业或专题/subject or field of study :

申请学习时间/ duration of specialized study:

自/from________年/year_____月/month_______日/day

至/to _________年/year______月/month_______日/day

3)此栏请博士研究生或高级进修生用汉语填写/to be filled out in chinese by doctoral

candidate or senior advanced student only

欲完成的论文题目：

本人希望的复旦大学的指导老师：

在复旦研究的详细计划（请另附纸张）：___________________________________________

5.经费来源/financial support

□自费/self-support

保证人或推荐单位名称及地址/guarantor's or company's name & address

________________________________________________________________________