徐州工业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

Xuzhou College of Industrial Technology

Please fill all the information requested. Handwriting is not acceptable. Please write none if not applicable.

姓 Last/Family Name SOUKHALAK

姓名
Name
(as shown 名 Given Name Mr SOUKKHASANH
on passport) 中 文 国 籍
宋海山 Laos
In Chinese Nationality
男 /Male þ 未婚/ Single þ 宗教信仰
Buddhism
女/Female □ 已婚/Married □ Religion
出生日期 出生地点 国家/Country Laos
2001 年/Year 03 月/Mon 30 日/Date
Date of Birth Place of Birth 城市/City Luangphabang
永久通讯地址及电话号码 国家/Country Laos 城市/City Luangphabang
Permanent Address and Tel. No. 邮政编码/Postal Code , 电话/Tel. No.
目前通讯地址及电话号码 国家/Country Laos 城市/City Luangphabang
Current address and Tel. No. 邮政编码/Postal Code , 电话/Tel. No.
!"#$%&'()*+,-./01 þ 234501 手机号码
Please send mails to: -Permanent Address - Current Address Cell phone Number
电子邮件 最后学历 Hight school
Khen59698569@gmail.com
E-mail Highest Education
护照号码 P2038595 护照有效期
2023 年/Year 06 月/Mon 17 日/Date
Passport No. Valid until
就读学校名称 Xuzhou Collega of Industrial Technology
Name of home school/college
就读专业 Aotomatic - Electric
最高学历情况 Major at home school/college
Highest Academic 入学日期 2023 / 09 / 01
Degree Entrance Date (yyyy/mm/dd)
就读时间 3 years
Number of years enrolled at home
school/college
汉语水平 HSK 考试或其他类型汉语考试成绩：
汉语学习时间：（ X ）个月 Band of HSK（Test of Chinese Proficiency）：（ X ）Grade
Chinese language （ X ）Months of Chinese Study or other certificates which can show your Chinese proficiency
proficiency
留学生类别 Categories of international students:
交换生 exchange student þ 语言生 Language student □ 预科生 Preparatory Student£
研修生 short time training student □ 专科生 Junior college student □ 本科生 Undergraduate □
申请学习专业 Desired major: INTERNATIONAL ECONOMY AND TRADE

学习期限 Period of study:

电话/手机
年 Year 月 Month 至 to 年
Year 月 Month Tel./Cell No.
会何种其他语言 到达时间
Proficiency in Other Foreign
Date of Arrival
Languages
(yyyy/mm/dd):
紧急情况联系人 Contact 1 (in home country)
 Emergency Contact (family, Name: Ms Bouashawanh SOUKHALAK Relationship: Mother
relatives, friends, etc.) Address: Laos E-mail: Mobile phone: +856 2022562929

Contact 2 (in China)

Name: Relationship:
Address: Mobile phone:
推荐单位 Name ： Xuzhou Collega of Industrial Tel: +86-516-85782828, 15162119529
student referral unit Technology
在华事务担保人 Name ： Xuzhou Collega of Industrial Mobile phone: +86-516-85782828, 15162119529
Guarantor in China Technology
在华留学经费担保人 Name：Ms Bouashawanh SOUKHALAK Mobile phone: +856 2022562929
Sponsor of study fund in China
申请人保证：
1． 上述各项中所提供的情况是真实无误的；
2． 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： 2023 年 07 月 02 日 申请人签名： SOUKKHASANH

Date: 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． 1.护照复印件 1. photocopy of passport
2． 2.高中或同等学历毕业证书、成绩单复印件 2. copies of graduation certificates and transcript
3． 3.体检表 3. Body check certificate
4． 4.护照照片 4. copies of passport photo
5． 5.无犯罪记录证明 5. Non criminal record certificate
6.银行存款证明 6. Bank deposit certificate
7.HSK-证书(仅限学历生提交) 7. HSK-4 certificate（Only academic diploma students submit）

6789:;<=
Views of
School Of International Education

>?/Signature: _____________ @A/Date _______B/Year ______C/Month _____@/Day

;DEF<=
Views of the President

>?/Signature: _____________ @A/Date _______B/Year ______C/Month _____@/Day

此申请表提交电子邮箱：1294099667@qq.com
Tel: +86-516-85782828, 15162119529