INTERNATIONAL STUDENTS APPLICATION FORM

英文姓 /Surname       
英文名/Given Name
性别/Sex
照片/Photo
中文姓名/Chinese Name
出生日期/Date of Birth
    年/Y    月/M     日/D  出生城市/City of Birth
  
护照号码/Passport  No.
国籍/Nationality
婚姻状况/Marital Status
  
现所属学习或工作单位/Employer or School Affiliated
宗教信仰/Religion
职业/Occupation
 
申请者所属国家家庭通讯地址/Students Local Home Address
家庭电话/Home Tel
 
电子邮箱/E-mail  移动电话/Mobile
以前受教育情况Previous Education
时间（从/到）Years Attended (from/to) 学校名称 Full Name of School/University 学校所在国
城市/city and country of the school/university 所获学位/Degree/Diploma
   
   
   
   

是否学习过汉语/Have you studied Chinese □否/No  □是/Yes
学过多久/How long have you studied Chinese?____________
汉语熟练程度(很好/好/一般/初级)/Chinese Proficiency(Excellent/Good/Fair/Beginnin)
  □ 阅读/Reading      □ 会话/Speaking        □ 书写/Writing          □ 听力/Listening

留学目的/Goal Information
攻读学位/Degree Seeking：       □学士/Bachelor     □硕士/Master     □博士/Ph.D.
不攻读学位/Non-Degree Seeking： □语言生/Language Student      □访问学者/Visiting Scholar
□普通进修生/Ordinary Training Student
□高级进修生/Advanced Training Student 
学习计划及专业/Your Plans and Discipline Major                                                                                                                            
 
在我校留学期限/Intended Duration at NCEPU
从/From    年/Y   月/M    到/To    年/Y    月/M

请注明在华北电力大学(北京)学习/研究的经费来源/Please specify the source of your financial support at NCEPU’BJ：
□奖学金/Scholarship     □自费/Self-Finance

工作简历/Previous Employment
时间（从/到）Years Attended (from/to) 单位名称 Full name of school/university 单位所在国家城市/City and country of the organization 职务/Duty
   
   

亲属情况/Family Members
姓名/Name 关系/Relationship 年龄/Age 职业/Employment 现所在国家/Country of current living place 
    
    
    

申请人品格：
你是否曾经：（每项后面请回答“否”或“是”）
Have you ever: (Each item must be answered “Yes” or “No”)
1在任何国家被判犯罪或犯法（包括现已从官方犯罪记录上删除的任何案底)？
been charged with any offence that is currently awaiting legal action?                         □No  □Yes
2被指控犯罪，现正等候法律诉讼？
been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?                                                                            □No  □Yes
3因精神病、精神错乱或精神不健全等原因，虽犯刑事罪或犯其他罪但被无罪开释？
been removed or deported from any country (including China)?                              □No  □Yes
4被任何国家驱逐或遣返（包括中国)？
left any country to avoid being removed or deported?                                      □No  □Yes
5为了避免被驱逐或遣返而离开某一国家？
left any country to avoid being removed or deported?                                      □No  □Yes
6被禁止进入某国或被要求离开某国(包括中国)？
been excluded from or asked to leave any country (including China)?                         □No  □Yes
7犯有或卷入战争罪行、反人类或反 人权的罪行？
committed, or been involved in the commission of war crimes or crimes against humanity or human rights?
□No  □Yes
8参与任何可能危及中国国家安全的活动？
been involved in any activities that would represent a risk to China national security?             □No  □Yes
9拖欠中国政府债务或中国任何公共机构债务而仍未归还？
had any outstanding debts to the China Government or any public authority in China?             □No  □Yes
10曾参与向任何国家（包括中国）非法移民的有关活动或因此类有关活动而被判罪？
been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including China)?                                                            □No  □Yes
11曾在军队或武装力量或国家支持/私人的民兵中服役，曾接受军事/准军事训练，或曾接受使用武器/炸药的训练（请描述)？
served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)?                                    □No  □Yes

如果你对上述任何一个问题回答“是”，那么请在下面说明所有相关细节。
If you answered ‘Yes’ to any of the above questions, give ALL relevant details below.
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申请人体格：
你过去是否患有下列疾病：（每项后面请回答“否”或“是”）
Have you ever had any of the following diseases? (Each item must be answered “Yes” or “No”)
1斑疹  伤寒 Typhus fever   □No  □Yes    2菌      痢 Bacillary dysentery            □No  □Yes
3小儿麻疹症 Poliomyelitis   □No  □Yes    4布氏杆菌病 Brucellosis                   □No  □Yes
5白      喉 Diphtheria     □No  □Yes    6回  归  热 Relapsing fever               □No  □Yes
7猩  红  热 Scarlet fever   □No  □Yes     8产褥期链球 Puerperal streptococcus infection □No  □Yes
9伤寒和付伤寒Typhoid and paratyphoid fever   □No  □Yes   
10菌  感  染 Bacterial infection     □No  □Yes
11流行性脑脊髓膜炎 Epidemic cerebrospinal meningitis       □No  □Yes     
12癌症 cancer        □No  □Yes
13哮喘等呼吸道疾病Asthma or other respiratory disease       □No  □Yes     
14肾病 kidney disease       □No  □Yes
15HIV病毒感染，包括艾滋病 HIV infection, including AIDS    □No  □Yes
16血液疾病 blood disorder         □No  □Yes
17乙型肝炎、丙型肝炎或其他肝病 hepatitis B or C and/or liver disease      □No  □Yes
18心脏病 heart disease       □No  □Yes
是否患有下列危及公共秩序和安全的病症：（每项后面请回答“否”或“是”）
Do you have any of the following diseases or disorders endangering the public order and security?
(Each item must be answered “Yes” or “No”)
19毒物瘾   Toxicomania                        □No  □Yes
20精神错乱 Mental confusion                    □No  □Yes
21精神病   Psychoses：
21.1躁狂型 Manic psychosis    □No  □Yes
21.2妄想型 Paranoid psychosis  □No  □Yes
21.3幻觉型 Hallucinatory       □No  □Yes
你是否曾经：（每项后面请回答“否”或“是”）
Have you ever: (Each item must be answered “Yes” or “No”)
22患过或现在患有肺结核病?
Had, or currently have, tuberculosis?                                                   □No  □Yes
23跟患有活动性肺结核的家庭成员有过密切接触？
Been in close contact with a family member that has active tuberculosis?                      □No  □Yes
24胸部X光片显示异常？
Had a chest x-ray which showed an abnormality?                                         □No  □Yes
25有晕厥、呼吸急促、心悸、肢体麻木、肌肉无力等症状？
Had symptoms include faintness, shortness of Breath, feeling the heart thumping, or numbness, or muscle weakness？                                                                       □No  □Yes                                                                        
26因为行动不便而需要协助，或者由于医疗方面的原因而需要护理？
Required assistance with mobility or care due to a medical condition?                         □No  □Yes
27最近12个月以来做过任何健康检查或疾病治疗？
Undertaken a health examination or medical treatment in the last 12 months?                   □No  □Yes

如果你对上述任何一个问题回答“是”，那么请在下面说明所有相关细节。
If you answered ‘Yes’ to any of the above questions, give ALL relevant details below.
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申请人保证/I Hereby Affirm That:

1. 申请表中所填写的内容和提供的材料真实无误；
     All information and materials given in this form are true and correct.
2. 在华期间，遵守中国的法律、法规，不从事任何危害中国社会秩序的、与本人来华学习身份不符合的活动；
     During my stay in China, I shall abide by the laws and decrees of the Chinese government, and will not participate in any activities in China which are deemed to be adverse to the social order of China and are inappropriate to the capacity as a student.
3. 来华后服从学校的安排，不得无故要求变更学校和所学专业；
I will agree to the arrangements of my institution and specialty of study in Beijing made by the University and will not apply for any changes in these two fields without valid reasons.
4. 在学期间，遵守学校的校纪、校规，全力投入学习和研究工作。尊重学校的教学安排；
     During my study in China, I shall abide the rules and regulations of the host university, and concentrate on my studies and researches, and follow the teaching programs arranged by the university.
5. 如违反上述保证，我愿意接受华北电力大学取消学习资格及其它相应的处罚。
     If I violated any of the above, I will not lodge any appeal against the decision of North China Electric Power University on expulsion, or other penalties.

申请人签字/Signature of the Applicant:____________________________ 日期/Date:___________
（无此签名，申请无效/The application is invalid without the applicant’s signature）