姓

Family Name

名

Given Names

性别

Gender

出生时间

Date of Birth

出生地点

Place of Birth

宗教信仰

Religion

国籍

Nationality

护照号码

Passport No.

护照签发时间

Passport issuance   time

护照签发地点

Passport issuance Place

护照有效期限

Passport

Expiration Date

本人电子邮件

Personal Email

本国通讯地址

Home   Address in Your Home Country

婚姻状况

Marital   Status

教育状况

Educational   Experience and the Highest Degree Obtained

工作经历

Professional   Experience

紧急情况联系人及联系方式Contact person in emergency

（Name, Relationship, Phone, Fax, Email）

本国

Home country

中国China

(if applicable)

拟在华学习期限，抵达学校时间

需声明的其他事项

Desired   Length of Studying at CCMC Date of Arrival, and other issues need to inform   CCMC

学费支付方式

Payment methods

此栏贴申请人的彩色护照照片

Please attach a passport-sized

color photo in this space.

来华留学经费来源Source of Funding

奖学金 /Scholarship□;自费 /Self-supporting□;其他 / Other□

经济担保人或机构 / Financial support will be provided by:

请阐述来华留学的动机和目的Please explain the motivation and purpose   of studying in China

请阐述现有汉语水平，包括：[1]您在何地学过汉语？学过多长时间？ [2]您是否参加过汉语水平考试？如参加过，成绩如何？

Please   declare your current Chinese Language Proficiency, including (1) Where and   for how long have you studied Chinese language?(2)Have you taken HSK (Chinese Proficiency   Test) before? What is the result if you have?

学生类别Category of Student

申请人保证：我已经阅读并理解了本入学申请表上所提出的所有问题，并在此基础上申请到葡萄新京官网学院留学深造。我保证本申请表上填写的所有内容真实无误。如果能够被录取，我将严格遵守中国的相关法律法规和葡萄新京官网学院对留学生管理的有关规章制度。

Certification by Applicant:

I have read and understood all   the questions set forth in this application, and hereby apply for admission.   If accepted, I will comply with all the rules and regulations of Chongqing City Management College. I certify that the information on this application is   true and correct to the best of my knowledge and belief.

Applicant’s Signature:

Date of Application:

长期汉语进修生

Long–Term Chinese   Language Training□

短期汉语进修生

Short–Term Chinese Language Training□

长期专业进修生

ProfessionalTraining□

学历生

Degree Study□

申请专业名称

（Program to Apply）

申请就读院（系）

(School/ Department to Apply)