常熟理工学院留学生入学申请表Admission Application Form for Foreign Students.doc

Application Form For International Students Wishing to Study at CIT ※ PLEASE TYPE COMPLETE INFORMATION IN ENGLISH. I. Personal Information (First) Name: (as shown on passport) Photograph (Middle) 3cmx4cm (Last/Family) (Affix your photo here Date of Birth (yyyy/mm/dd): after print Nationality: Sex： this form) Passport No.: Marital Status: Occupation: Religion: Current Employer or School: Highest Academic Degree Obtained: E-mail Address: Home phone: Mailing Address: Postal Code: Mobile phone: Ⅱ. Academic Information  Home University（For Exchange-Student） Name: Major at home university: Entrance date (yyyy/mm/dd): Number of years enrolled at home university:  year(s) Changshu Institute of Technology Field of Study: Length of Study: From （Year） Ⅲ. Chinese Language Background （Month） to （Year） （Month） （ ）Months of Chinese Study Band of HSK（Test of Chinese Proficiency）：（ ）Grade Chinese Language Proficiency 1. Speaking: □ Beginner □ Intermediate □ Advanced □ None 2. Listening: □ Beginner □ Intermediate □ Advanced □ None 3. Reading: □ Beginner □ Intermediate □ Advanced □ None 4. Writing: □ Beginner □ Intermediate □ Advanced □ None Ⅳ. Request for Dormitory Will you require on-campus accommodation？ Yes（ ） No（ ） Date of Arrival(yyyy/mm/dd) :  Dormitory fee need to be paid with 2 weeks after arrival.  Students are responsible for carrying with themselves such items as blankets, bed sheets and pillows. You can buy them in China or bring them with you from your country. Ⅴ. Emergency Contact (family, relatives, friends, etc.) Contact 1 (in home country) 1. Name: 3. Address: Contact 2 2. Relationship: Street: Country: Postal Code: Home phone: Mobile phone: (in China) 1. Name: 3. Address: 2. Relationship: Street: Country: Postal Code: Home phone: Mobile phone: I affirm that all information given above is complete and correct to the best of my knowledge. I u nderstand that deliberate falsification or omission of information on this form may result in disqu alification or cancellation of admission. Signature: Date: