Application Form for Foreigners Wishing to Study In

Application Form for Foreigners Wishing to Study in

WEST CHINA CENTER OF MEDICAL SCIENCES SICHUAN UNIVERSITY

Name： Family name First Name Middle Name

Date of Birth: Sex: Photo Year Month Day □ Male □ Female

Place of Birth: Marital Status: □ Single □ Married Nationality: Native Language: Passport No: Religion:

Present Address:

Tel: Fax: E-mail:

Educational Background (to the time of application): Institutions Years Attended Field of Study Certificate Obtained (from/to) Work Experience: Employer Time (from/to) Work Engaged Posts Held

Language Proficiency: Reading Listening Writing Speaking □ Excellent □ Excellent □ Excellent □ Excellent Chinese: □ Good □ Good □ Good □ Good 1 □ Fair □ Fair □ Fair □ Fair □ Poor □ Poor □ Poor □ Poor

□ Excellent □ Excellent □ Excellent □ Excellent English: □ Good □ Good □ Good □ Good □ Fair □ Fair □ Fair □ Fair □ Poor □ Poor □ Poor □ Poor

□ Excellent □ Excellent □ Excellent □ Excellent Other: □ Good □ Good □ Good □ Good □ Fair □ Fair □ Fair □ Fair □ Poor □ Poor □ Poor □ Poor

Plan of Study in China: a) □ Bachelor’s Degree Candidate □ General Scholar □ Master’s Degree Candidate □ Senior Scholar □ Doctoral Candidate □ Research Scholar □ Short-term study □ Medical practice b) Subject or Field of Study: c) Duration of Specialized Study: From Year Month To Year Month d) Do you need elementary Chinese study prior to specialized study? No: □; Yes: □ If “Yes”, please indicate the duration of your elementary Chinese study (Not included in the length of specialized study): From Year Month To Year Month Academic papers, writing works published:

Please describe the details of your study or research plan in China (An extra paper can be attached if this space is not enough):

Source of Financial Support： □ Organization □ Family □ Individual Please specify the organization or person who recommends you to study in China:

The guarantor charging your case in China: Name: Address:

Tel: Fax: E-mail: Guarantor’s signature:

Have you ever studied or worked in China? If “Yes”, please give details: Employer: Time in China:

Members of Family:

I. Name Age Occupation Spouse: Father: Mother: Applicant’s permanent address: I hereby affirm that: 1. All the information and materials given in this form is true and correct; 2. 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 be adverse to the social order in China and are inappropriate to the capacity as a student; 3. 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 follow the teaching programs made by the university; 4. I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid reasons; 5. If I am judged by the Chinese laws and decrees and the rules and regulations of the university as having violated any of the above, I will not lodge any appeal against the decisions of the relevant authority.

Applicant’s signature: Date:

The application is invalid without the applicant’s signature）

Important Notes: 1. This form is to be completed either in Chinese or English only. An incomplete application or completed in languages other than in Chinese or English is invalid. 2. One original Application Form and one photocopy must be sent to the Office for International Cooperation, WCUMS by May 31st preceding the academic year, and must be supported by the following materials (in photocopy): ● Two letters of recommendation (for postgraduate candidates) ● Diploma of most advanced studies (notarized photocopy) ● Transcripts (notarized photocopy)