Application Form for MBBS programme

1．姓名(Family name ) 2．出生日期(Date of birth)

(Given name)
3．国籍(Nationality) 4．性别(Sex) 5．婚姻状况(Marital status)
照 片
Photo
6．宗教信仰(Religion) 7．护照号码(Passport No.)

8．家庭地址/电话号码/邮箱地址(Home Address & Telephone Number& Email Address)

9．目前工作或学习单位（Present employer or Institution affiliated）

10．受教育情况/Educational background:
最终毕业学校 在校时间 主修专业 所获毕业证书及学位证书
the latest school graduated Years attended (from / to) Field of study Certificate obtained

11．语言能力/Language proficiency:
会 话 阅 读 写 作
Speaking Reading Writing
汉语/Chinese:
英语/English:
其它/Other:
* 请用很好、好、一般或不会自行评价并填入空格/Evaluate your ability as Excellent, Good,
Fair or Poor in the blank.
12．来华学习计划/Plan of study in China:
a.) 本科生/Bachelor’s degree candidate:□; 普通进修生/General Scholar:□
硕士研究生/Master’s degree candidate:□; 高级进修生/Senior Scholar:□
博士研究生/Doctoral candidate:□; 研究学者/Research scholar:□
语言学习生/Language student:□
* 请在所选的项目方框内打“×”/Please indicate with a cross in the bracket.
b.)在华学习时间/Planned time to study in China:
自/From 年/Year 月/Month 至/To 年/Year 月/Month

13．申请人经费来源/Source of financial support:

团体资助/Organization:□; 家庭资助/Family:□; 个人支付/Individual:□
14.申请人亲属情况/Members of family:
姓 名 年 龄 职 业
Name Age Employment
配偶/Spouse:
父亲/Father:
母亲/Mother:
15.
I solemnly declare that:
a) The information provided in my application form and the documents attached are correct and
true to the best of my knowledge, if there is any incorrect information or false documents, I will
be disqualified for the admission.
b) I shall attend at least 90% of the classes till the final year & will be punctual.
c) I will pay my tuition and hostel fee in time, if due, the university can suspend/expel me from
the university temporarily or permanently. Any fees paid will not be refundable.
d) As a student enrolled in Guangzhou Medical University, I understand, accept and agree to
abide by the rules, regulations and policies of the university and the local government.
e) During my study in GMU, I agree to live in the campus of GMU.
f) During my study in GMU, I agree to do the internship in the hospitals that GMU arranges for
me in China. I am not going back to my country for the internship.
g) 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.

If I do not follow the rules and regulations mentioned above, I agree to be punished, suspended or
expelled from the university

Signed: _______________ Date: ____________

我声明：
a) 申请表及附件里的信息均属实，如若有假，请取消我入学申请资格；
b) 学习期间，我将准时到校，并参加至少 90%的课程；
c) 我将准时交纳学费与住宿费等规定费用，如到期未交，学校可中止我的学习或给予开
除处理；所交费用绝不要求退还；
d) 作为广州医科大学的一名申请者，我了解、接受且同意贵校和当地政府的规章制度和
政策；
e) 在广州医科大学学习期间，我同意在学校安排的宿舍住宿，不自行在校外居住。
f) 在广州医科大学实习期间，我同意在学校安排的实习医院实习，不回国实习。
g) 在中国学习期间，我将遵守中国政府的各项法律条例，决不参加任何有违学生身份的
扰乱社会秩序的活动；
以上所述如未能做到，我甘愿接受惩罚，学校可以取消我的学习资格或将我开除。

签名：______________ 日期：______________