上海体育学院国际学生入学申请表

Application Form for Foreign Students to SUS Apply No.:20200300020

申请人信息 / Personal Information

护照姓名 姓/Surname： ABDALLAH-MAHDJEBI
姓名 Passport Name 名/Given Name： ABDERAOUF
Name 中文姓名（不超过6个汉字）
In Chinese (no more than 6 Characters)
出生地点/Place of Birth 出生日期/Date of Birth
阿尔及利亚 TIBERKANINE 1994-11-23
国籍/Nationality 婚否/Marital Status 健康状况/Health Status
阿尔及利亚 单身 Good
宗教/Religion 母语/Native Language 爱好/Hobbies
伊斯兰教 阿拉伯语 Sports,Reading , Drawing
性别/Gender 护照号码/Passport No. 护照有效期/Passport Validity
男 197230704 2029-08-02
最高学历/Highest Diploma 职业/Occupation 工作或学习单位/Employer or Institution Affiliated
硕士 职员 CRBA FOOTBALL PLAYER
手机/Cell-phone 电话/Telephone 电子邮件/E-mail
0021368480572 abderaoufa491@gmail.com
联系地址（录取通知书邮寄地址）/ Present Address (Mailing Address：House Number, Street Name, District Name,City
Name, Zip Code and Contact Person)

Hay 86 Mesken Hay Salem EL ATTAF , AINDEFLA , ALGERIA EL ATTAF AIN DEFLA Algeria ABDERAOUF
详细的永久居住地址/Permanent Residence Address in details
Hay 86 Mesken Hay Salem EL ATTAF , AINDEFLA , ALGERIA,EL ATTAF AIN DEFLA,Algeria
语言能力 / Language Proficiency
汉语能力
汉语能力：差; 无
Chinese Proficiency
英语能力
English Proficiency
教育背景（从高中起）/ Educational Background (From High School)
在校期间 (From/To) 学校 (Institutions) 所获学历（Certificate）
2017-09-03 — 2019-07-22 Institute of physical and Sport Education Science & Techniques of

2014-09-03 — 2017-07-06 Institute of physical and Sport Education Science & Techniques of

2010-09-05 — 2014-06-29 ABI BAKR ESSEDIK HIGHT SCHOOL Technical Mathematics and

本人工作经历 / Employment Record

起止时间 (From /To) 工作单位 (Employer) 职务及职称 (Posts Held)
2010-01-01 — 2020-03-20 CRBA FOOTBALL CLUB FOOTBALL PLAYER
 留学中国计划/Study Plan in China
非学历生项目/Non-degree Programs 学历生项目/Degree Programs
博士研究生/Doctoral Student
申请院系/Department: 体育教育训练学院 学习期限/Duration: 2020-09-01 to 2023-07-15
申请专业/Major: 体育教育训练学 经费来源/Funds: null
专业方向/ Major Orientation： 体育教育训练学 授课语言/Teaching language: 汉语 / Chinese
申请人亲属情况 / Family Members
姓名/Name 职业/Occupation 电话/Tel.
母亲/Mother Fatma Teacher,Retaired 00213698460980
父亲/Father Mohamed Teacher,Retaired 00213790590685

最近三次入境签证记录 / 3 recent Visas to China

/No 逗留时间（月）/Duration 签证类型/Visa type 原因 / Reason

推荐单位（人）信息 / Information for Reference

姓名/Name 工作机构/Organization 电话/Tel. 邮箱/E-mail

联系地址/Address
在华事务担保人 / The Guarantor Charging Your Case in China
姓名/Name 工作机构/Organization 电话/Tel. 邮箱/E-mail
MEDAOUAR MOHAMED Central South University +8613017295783 medaouarmo@gmail.com
联系地址/Address Hunan, changsha,Yuelu District ,Central South University ,South Campus
经济担保人或机构 / Financial Guarantee
姓名/Name 工作机构/Organization 电话/Tel. 邮箱/E-mail
Mohamed non 00213790590685 mohamedmehdjebi@gma
联系地址/Address Hay 86 Mesken Hay salem EL ATTAF AIN DEFLA , ALGERIA
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的。
All the information given in this form is 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秩序的、与本人来华学习身份不相符的活动。
During my stay in China, I shall abide by the laws and decrees of the Chinese Government, and will not participate in any activities, which
are deemed to the social order in China and inappropriate to the capacity as a scholar or student.
3.在学期间，遵守学校的校规校纪，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 observe the rules and regulations of the university, and will concentrate on my studies and researches, and
will following the teaching programs made by the university.

日期/Date: 2020-03-21 申请人签名/Applicant's signature:

◆若无签字，则视为无效申请/ The application is invalid without the applicant's signature.