] Application Form for Foreigners to Study in Xidian University , Xi ’an, China

Name： Family Name Given Names Sex：

Nationality： Passport No.： Marital Status： Photo

Date of Birth： year month day Place of Birth：

Occupation： Highest Academic Degree Obtained: Religion：

Employer or Degree Obtained：

Mailing Address：

Duration： From Yr. Mo. To Yr. Mo.

Educational Background：

Present Level of Chinese

Check the appropriate box to indicate the number of Chinese words you know. A None B about 200 C about 600 D about 1000 E over 2000 Program applied for:

1. major 2. Non-degree courses ① Primary Chinese Class ② Intermediate Chinese Class ③ Advanced Chinese Class ④ Preparation for University 3. Degree courses ① Bachelor (4 years) □ ② Master(2.5 years) □ ③ Ph.D. (3-5 years) □  International students, who will study their major in Chinese language, need to pass HSK certificate level 3-6. Source of Funding： Scholarship □ ； Self-supporting □ ； Other □

Financial support will be provided by：

Reference：

I here by affirm that： 1. All the information in this form is true and correct; 2. I shall abide by the laws of the Chinese Government and the regulations of the university.

Signature of Applicant： Date：