姓 Family Name:                                名Given Name:

照片

Photo

国籍Nationality：            性别Sex：        护照号码Passport No.：

出生日期Date of Birth：                       出生地点Place of Birth：

健康状况Health Status：      婚否 Marital Status：        宗教信仰Religion：

本国通讯地址HOME Address：                                 

电话号码 Phone No.

电子邮箱Email：

本人最高学历Highest Academic Degree Obtained:

本人学习（工作）简历Working Biographical Notes：

现有汉语水平Present Proficiency of Chinese

学习过汉语 Learned Chinese:   是 Yes□   否No □

已经学习过   个月汉语                              months of Chinese learning

已经达到HSK   级                                  band of HSK (Test of Chinese Proficiency) achieved

留学类别Categories of International Students:

①本科生Undergraduate □                        ②硕士研究生Master's candidate □

③博士研究生Doctoral candidate □               ④汉语进修生Chinese Language Learner □

留学期限Duration of study (from/to)

申请学习专业Applying for(specialty):

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？

本人保证：
上述各项中填写的内容是真实无误的。
在哈尔滨工程大学学习期间，遵守中国的法律和学校的规章制度。

I here affirm that:

All the information in this form is true and correct.
I shall abide by the laws and rules in China and the regulations of Harbin Engineering University.

申请人签字：                                                           日期：         年     月      日
Applicant's signature:                                                 Date：          Y      M       D