外国留学生入学申请表

Application Form for International Students

请用中文或英文填写此表/Please complete the form in Chinese or English.
姓/Family name：MATNIYOZOVA
英文姓名（以护照用名为准）
In English (Same as in your Passport)
姓名 名/Given name：DILOROM
Name

中文姓名 Chinese name NO

性别 Sex M □ F ■ 国籍 Nationality 乌兹别克斯坦

母语 Native Language 乌兹别克语 最高学历 Highest Education 高中

婚姻状况 Marital Status 已婚 Married ■ 未婚 Single □ 宗教信仰 Religion 伊斯兰教

护照号码 Passport No. FA0882441 有效期至 Valid Until 2029-11-21

出生地国家 : UZBEKISTAN 城市 : UZBEKISTAN

出生日期 Date of Birth 1995-10-22
Country of Birth City of Birth
是否持有在华有效签证？ 否 签证类型 有效期
Do you have valid Visa in China Type of visa Valid until
签发单位（学校/公司/中介机构）
Source of Present Visa (Which School /Company/Agency? )
最后学历 高中 专业 BANKING
Highest degree obtained Major
毕业院校 在校时间
School of graduation YANGIARIC INDUSTIAL ECONOMIC Years Attended 2012-09-04--2015-06-25
PROFESSIONAL COLLEGE
目前所在学校或机构 职业 家庭主妇
Place of study or work：COLLEGE Occupation
本人联系方式 电话 Tel./Mobile 电子邮件 E-mail diloromovna@mail.ru
My Contact Information

录取通知书邮寄地址 Address for Admission Notice

(Please inform the International Cultural Exchange for any change of this address)
UZBEKISTAN TASHKENT olmazor sariqsuv 41

姓名 Name 电话 Tel./Mobile 电子邮件 E-mail

在华紧急事务联系人 SAYYORA +998946032408 sayora611@yahoo.com
Contact on Emergencies +998946032408
in China 联系地址 Address Uzbekistan

关系 姓名 Name 电话 Tel./Mobile 电子邮件 E-mail

Relationship DILNOZA +998996498866 diloromovna@mail.ru
经济担保人或机构 I
Financial Supporter
联系地址 Address
olmazor sariqsuv 41

语言能力，请用“好、一般、不会”评价。 Language proficiency (Good/Little/None)

汉语 Chinese 一般 HSK: 二级 HSKK: 无

英语 English 零基础 TOEFL : IELTS:

其它 Other UZBEK GRE: GMAT:

留学类别/Categories of International Students I Apply for

□ 本科生 Bachelor’s Program □ 硕士研究生 Master’s Program □ 博士研究生 PhD program
■ 语言生 Chinese Language Program □ 普通进修生 General Scholar □ 高级进修生 Senior Scholar
授课语言 Teaching Language
■中文授课 Chinese-taught □ 英文授课 English-taught
拟申请学习的专业 汉语言
Subject or Field of Study I Apply for
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 申请学习时间 自 From: 2023 年/Year 09 月/Month 01 日/Day
Duration 至 To: 2024 年/Year 09 月/Month 01 日/Day
费用来源
■ 自费/Self-supporting □ 奖学金/Scholarship
Financial Support
名称 Name 电话 Tel./Mobile 电子邮件 E-mail
推荐单位或个人 /
Recommended or individuals 地址 Address

家庭成员 Family Members

关系 Relationship 姓名 Name 国籍 Nationality 职业 Occupation 联系电话 Tel 电子邮件 Email
父亲 ATABEK 乌兹别克斯坦 其他 +998974449119 diloromovna@mail.ru

本国家庭地址 Home Country Address：

Mkrzo Ulugbek

教育经历
Education Experience

开始时间 结束时间 学校名称 所在国家 学位 专业方向

Year Attended (From) Year Attended (To) School Name Country Degree Type Field of Study & Diploma received

2012-09-04 2015-06-25 YANGIARIC 乌兹别克斯 34 BANKING

INDUSTIAL 坦
ECONOMIC
PROFESSIONAL
COLLEGE

工作经历
Work Experience

开始时间 结束时间 机构名称 职位

Year Attended (From) Year Attended (To) Name of Organization Position

申请人保证 I hereby affirm that:

我自愿申请前往西安外国语大学学习，网上申请将由本人亲自填写。在此，本人郑重声明我将严格遵守中华人民共和国法律法规，及
西安外国语大学校纪校规。所有我本人提供的信息及文件均真实有效。任何弄虚作假行为将导致学校取消我的申请资格。我清楚所有申请
相关信息，包括在西安外国语大学学习期间所产生的全部费用。同时我也清楚需要提前向西安外国语大学支付第一年学费。之后按照西安
外国语大学规定按学期或按学年付款。我清楚滞后付款和欺诈行为将导致罚金处罚甚至取消居留许可资格。其他任何组织或个人不可以西
安外国语大学的名义向我收取学费。本声明具有法律约束力。如果声明人违反任何规定条款，西安外国语大学有权对其采取法律措施。

I would like to apply to study at Xi’an International Studies University（XISU）. I will fill online application myself. Hereby I solemnly declare
that I will observe the laws and decrees of China as well as the rules and regulations of XISU, and all my information and documents provided are true
and authentic. I understand that any false or inaccurate document may result in the cancellation of my admission status at XISU. I am clear with all the
relevant information of application including all the fees incurred to study at XISU. I am also aware that I have to deposit one-semester tuition fee to the
university account in advance for the first time. Afterwards I will pay punctually by semester or by year as the university stipulates. I understand behind
payment and defraud may result in penalty fee even as much as cancellation of residence permit. No other individuals or organizations are supposed to
collect my school fees in the name of the university. This declaration is legal binding. XISU reserves the right to take legal action against the declarer if
he or she breaks any term stipulated.

日期/Date 申请人签字/Applicant’s signature____________________

申请人在递送本申请表的同时，请提交/ Please offer the following materials with the application form:

（1） 最后学历证明（公证件）/An official certificate of your highest education (notarized version)

（2） 学习成绩单（公证件）/An official transcripts (notarized version)

2
（3） 推荐信/Two letters of recommendation(original)

（4） 汉语水平证明/英语水平证明 Chinese level certificate/ English level certificate

（5） 护照复印件/copy of your passport

无论申请人是否被录取，上述申请材料恕不退还
Whether the candidate is accepted or not, all the application material will not be returned