中國(guó)100青年英才培養(yǎng)計(jì)劃報(bào)名表

1、中國(guó)100青年英才培養(yǎng)計(jì)劃報(bào)名表姓名性別民族相片出生年月身份證號(hào)家庭電話手機(jī)E-mail通訊地址郵編就讀學(xué)校專業(yè)（文科/理科）就讀年級(jí)擔(dān)任職務(wù)現(xiàn)任/曾任校內(nèi)外社會(huì)工作及獲獎(jiǎng)情況由/至（年/月）活動(dòng)名稱活動(dòng)規(guī)模（國(guó)際/國(guó)內(nèi)/跨校/校內(nèi)）擔(dān)任職務(wù)日期曾榮獲的獎(jiǎng)項(xiàng)曾獲與學(xué)業(yè)成績(jī)相關(guān)的校內(nèi)、外獎(jiǎng)學(xué)金（按順時(shí)序列出日期獎(jiǎng)學(xué)金名稱頒發(fā)機(jī)構(gòu)志愿者服務(wù)或社會(huì)服務(wù)經(jīng)驗(yàn)日期服務(wù)內(nèi)容服務(wù)時(shí)數(shù)服務(wù)機(jī)構(gòu)組織/參與語(yǔ)言能力（請(qǐng)?jiān)谙鄳?yīng)水平打英語(yǔ)精通良好一般其他（）精通良好一般請(qǐng)撰寫一篇名為我對(duì)英才的理解及自身與英才目標(biāo)的比較的短文，字?jǐn)?shù)不超過500字（可另附）申請(qǐng)人認(rèn)為需要補(bǔ)充的資料：聲明書在簽署本表格同時(shí)，本人確認(rèn)：1

2、.本表格及隨附文件所提供的資料均正確無誤，并無缺漏；2 .若成功獲選，將承諾全力參與中國(guó)100培訓(xùn)計(jì)劃的學(xué)習(xí)、考察活動(dòng)，達(dá)到課程要求；3 .若成功獲選，將承諾愿意竭盡所能，服務(wù)社會(huì)；4 .若成功獲選，同意自動(dòng)成為中國(guó)100青年英才俱樂部會(huì)員，并同意將以上個(gè)人資料用作中國(guó)100青年英才俱樂部的聯(lián)絡(luò)及通訊。申請(qǐng)人簽名：年月日就讀學(xué)校負(fù)責(zé)人推薦（報(bào)名表須交學(xué)校填寫及蓋章）名稱負(fù)責(zé)人姓名負(fù)責(zé)人職務(wù)職稱聯(lián)系方式聯(lián)絡(luò)地址郵編負(fù)責(zé)人對(duì)申請(qǐng)人的評(píng)價(jià)：在簽署本表格時(shí)，本人確認(rèn)：1 .以上申請(qǐng)人所填寫的校內(nèi)成績(jī)及校內(nèi)社會(huì)工作資料均正確無誤；2 .同意中國(guó)100»青年英才培養(yǎng)計(jì)劃辦公室向本人及本校收集本人

3、及受推薦人的資料，以作審核此次報(bào)名之用。負(fù)責(zé)人簽名：蓋章：年月日年月日一家長(zhǎng)意見我同意并支持參加中國(guó)100青年英才培養(yǎng)計(jì)劃所有學(xué)習(xí)和社會(huì)活動(dòng)。家長(zhǎng)簽名：年月日China100YouthEliteProjectApplicationFormNameGenderNationPhotoDateofBirthID.CardNo.HomeTel.No.MobileE-mailCorrespondenceAddressZipCodeCurrentSchoolMajor(Arts/Science)GradePost(s)Current/PreviousSocialWorkandPrize(s)Innside

4、andOutsideSchoolFrom/To(yy/mm)NameofActivityScaleofactivity(International/National/Inter-school/Insideschool)Post(s)Date(s)PreviousPrize(s)PreviousAcademic-relatedScholarship(s)/Prize(s)(Inchronologicalorder)Date(s)Scholarship(s)IssuingBody(ies)VoluntaryWorkorCommunityServiceExperienceDate(s)Content

5、ofServicehour(s)ofSenrice(s)NameofOrganisation(s)Organizeorparticipate,LanguageProficiency(markupatTliecorrespondingplace)EnglishExcellenceGoodFairothers()ExcellenceGoodFairPleasewriteanessayofnomorethan500wordsinChineseentitledkMyunderstandingofYouthElite,andmyAdvantageandshortcomingcomparisonwitht

6、heobjectivesofYouthElite".AdditionalInformationofApplicant:DeclarationUponcompletingandsigningthisApplicationForm.IconfirmthatI:5.certifythatalltheinformationprovidedaboveandalltheenclosedsupportingdocumentsarecompleteandaccuratetothebestofmyknowledge;6.shallmakeeveryefforttothechina100Projecta

7、ndReachtheCoursesRequirements,ifsuccessful；7.shallmakeeveryefforttotheservethecommunitywithdevotion,ifsuccessful：8.herebygivemyconsenttobecomeamemberof"China100"YouthEliteProjectandtoreleasemypersonalinformationgivenabovefonifsuccessful;SignatureofApplicant:Date:RecoininendationfromPrincip

8、alofRespectiveSchool(Applicantsshouldsubmittheformtoschoolforcompletionandcertification)NameofSchoolNameofPrincipalPost(s)ofPrincipalTitleTel.No.CorrespondenceAddressZipCodeCommentsonApplicantfromPrincipal:UponcompletingandsigningthisApplicationForm,IconfirmthatI:1 .certifythatalltheinformationtheap

9、plicantprovidedrelatedtoacademicrankandleadershippost(s)atschoolareaccuratetothebestofmyknowledge;2 .givemyconsenttotheSecretariatof"China100"YouthEliteProjecttocarryoutnecessaryreferencecheckandinvestigationwithmyselformyschoolforthepurposeofassessingthisapplication.SignatureofPrincipal:S