江苏经贸职业技术学院外国留学生来华学习申请表

APPLICATION FORM FOR INTERNATIONAL STUDENTS TO STUDY AT

JIANGSU VOCATIONAL INSTITUTE OF COMMERCE
Please fill all the information requested. Handwriting is not acceptable. Please write None if not applicable.
姓 Last/Family
姓名 MAHMUD
Name Name

(as shown 名 Given Name MULYANI

on
中文 国籍
passport) INDONESIA
In Chinese Nationality

宗教信仰
男/male 未婚/ Single ISLAM
Religion

出生日期 2003 年 /Year 7 月 /Mon 3 出生地点 国家/Country INDONESIA

Date of Birth 日/Date Place of Birth 城市/City BOALEMO
永久通讯地址及电话号码 国家/Country INDONESIA 城市/City BOALEMO
Permanent Address and Tel. No. 邮政编码/Postal Code , 96261 电话/Tel. No. 082146351954
国家/Country INDONESIA 城市/City BOALEMO
目前通讯地址及电话号码
邮政编码/Postal Code , 96261 电话/Tel. No. 082146351954
Current address and Tel. No.
地址/Address. Kab. Boalemo Kec. Paguyaman Desa Wonggahu
您希望我们将邮件寄到：目前联系地址 手机号码
Please send mails to: Current Address Cell phone Number
电子邮件 最后学历 SENIOR HIGH SCHOOL
Yanimahmud18@gmail.com
E-mail Highest Education
护照号码 护照有效期
C9491999 2027 年/Year 8 月/Mon 5 日
Passport No. Valid until
就读学校名称
SMA Negeri 01 Paguyaman
Name of HomeUniversity
就读专业
SCIENCES
学习经历 Major at HomeUniversity
Academic 入学日期
May, 09 2022
Information Entrance Date (yyyy/mm/dd)
就读时间
Number of years enrolled at home 3 Years
university
汉语水平 HSK 考试或其他类型汉语考试成绩：
汉语学习时间：（）个月 Band of HSK（Test of Chinese Proficiency）：（）Grade
Chinese language or other certificates which can show your Chinese proficiency
proficiency
1.
一般 Intermediate
Speaking
2.
一般 Intermediate
Listening
3. 一般 Intermediate
Reading
 4. Writing 一般 Intermediate
留学生类别 Categories of international students:
专科生 Junior college student
申请学习专业 Desired major:

学习期限 Period of study: 电话/手机

年 Year 月 Month 至 2021 年 10 月至 2025 年 7 月
to 年 Year 月 Month Tel./Cell No.
会何种其他语言 到达时间
Proficiency in Other Foreign 英文– Date of
Languages 2021 / 10/08
Arrival(yyyy/mm/dd
):
Contact 1 (in home country)
Name: SURATNI MANTUU Relationship: Parent (Mother)

紧急情况联系人 Address: Kab. Boalemo Kec. Paguyaman Mobile phone: 085340911324

Emergency Contact (family, Desa Wonggahu
relatives, friends, etc.) Contact 2 (in China)
Name: Relationship:
Address: Mobile phone:
申请人保证：
． 上述各项中所提供的情况是真实无误的；
． 在中国学习期间遵守中国的法律和学校的规章制度，不从事任何危害中国社会 秩序的，与本人来华学习身份不相符合的活
动。
I hereby affirm that:
1. All the information in this form is true and correct;
2. I shall abide by the laws of China and the regulations of the School, and will not participate in any activities,which are deemed to be
adverse to the social order in China and are inappropriate to the capacity as a student.

日期：2021 年月日申请人签名：
Date: Y M D Applicant’s Signature

注：申请人在递送本申请表的同时，请提交 Remarks: The applicant is required to submit:

． 1.护照复印件 1. photocopy of passport
． 2.最后学历证明复印件 2. photocopy of highest education certificate
． 3.体检表 3. Body check certificate
． 4.学习、工作经历证明复印件 4. photocopy of academic and work experience certificate

国际教育学院意见
Views of
School of International
Education
签字/Signature: _____________ 日期/Date _______年/Year ______月/Month _____日/Day

院长审批意见
Views of the principal

签字/Signature: _____________ 日期/Date _______年/Year ______月/Month _____日/Day