北京大學(xué)醫(yī)學(xué)部外國留學(xué)生預(yù)科生入學(xué)申請表

1、北京大學(xué)醫(yī)學(xué)部外國留學(xué)生預(yù)科生入學(xué)申請表APPLICATION FORM FOR INTERNATIONAL STUDENT(Please type or print)護(hù)照用名 / Name in Passport:Family Name:Give n Name:中文姓名 / Name in Chinese, if applicable:相片Photo性別Sex婚姻狀況Marital Status國籍Citize nship宗教信仰Religio n出生日期年月日Date of BirthYearMon thDate出生地點(diǎn)Place of Birth護(hù)照號碼Passport No.有效期至年

2、月Valid Un tilYearMon th最后學(xué)歷及獲得時(shí)間Highest Educatio n Level and the date obta ined or to obta in當(dāng)前學(xué)習(xí)或任職單位Curre ntly In stituti on En rolled/Employed職業(yè)Occupati onE-mail:目前聯(lián)系地址及電話 / Curre nt Maili ng Address & Tel永久通訊地址及電話 / Perma nent Maili ng Address & Tel受教育情況 /Education Background在校時(shí)間Years At

3、te nded學(xué)校In stituti ons主修專業(yè)Fields of Study學(xué)位Certificates工作經(jīng)歷 /Employment Record起止時(shí)間Time （ from/to）工作單位Employer從事工作Work En gaged職務(wù)Positi on申請專業(yè)醫(yī)學(xué)口口腔醫(yī)學(xué)口藥學(xué)口英語口Subject you wish to apply forMedici neStomatologyPharmacyEn glish漢語水平很好口好口一般口差口不會(huì)口Chin ese Proficie ncyExcelle ntGoodFair是否申請預(yù)科學(xué)習(xí)一年P(guān)oorNone是口不是口

4、NoDo you want to take a one year program of eleme ntary Chin ese studyYes經(jīng)濟(jì)擔(dān)保人姓名 Name of Finan cial Guara ntor 職業(yè)Occupati on通訊地址 / Maili ng Address申請入學(xué)時(shí)間 /Year apply for entry:在華事務(wù)擔(dān)保人姓名Name of Spon sor in China推薦單位In stituti on or Compa ny通訊地址 / Maili ng Address聯(lián)系電話/ Tel 聯(lián)系電話/ Tel 申請人保證：1. 上述各項(xiàng)中所提供的

5、情況是真實(shí)無誤的；2. 在校學(xué)習(xí)期間遵守中國政府的法規(guī)和學(xué)校的規(guī)章和制度；3. 遵守學(xué)校的規(guī)定交納各項(xiàng)費(fèi)用。I hereby affirm that:1. All the information I provided above is true and correct;2. I shall abide by the laws of the Chin ese Gover nment and the regulati ons of Peking Uni versity;3. I will pay the fees as outl ined in the regulati on.申請人簽字/ Sig

6、nature:日期/ Date:注：申請人請將以下材料同時(shí)郵寄到北京大學(xué)醫(yī)學(xué)部留學(xué)生辦公室：1.八百人民幣申請費(fèi)(現(xiàn)金)2.簡歷3.學(xué)習(xí)成績單、畢業(yè)證書或大學(xué)在校證明和身份證明的復(fù)印件4經(jīng)濟(jì)狀況證明 5.申請臨床醫(yī)學(xué)和口腔醫(yī)學(xué)專業(yè)者另需提供身體健康證明并附肝功能及乙肝表面抗原化驗(yàn)單。Remarks: Please send the form and the following materials to the address below: 1.Applicationfee,RMB 弱00 ( cash ) 2.Resume 3. Official transcripts, Photocopy of graduate certificate, Identity Certificate 4. Financial statement (In Chinese or English).郵寄地址：Mailing Address:郵政編碼100083Foreig n Stude nt Office中國北京市海淀區(qū)學(xué)院路38號Peking Uni versity Health Science Cen ter北京大學(xué)醫(yī)學(xué)部留學(xué)生辦公室Beiji ng 100083, Ch ina電話:8