application form for chinese studentes wishing to study at uec
申请人认真阅读本表末页的注意事项后再填写下列诸项：
please read the important notes at the end of the form carefully before filling in the form
1.申请人简况/personal information
姓/family name________________________ 名/given name________________________
中文名/chinese name______________ 国籍/nationality___________性别/sex____________
出生年月/date of birth:___________年/year______月/month______日/day
出生地点/place of birth___________________ 婚姻状况/marital state___________________
护照号码/passport no____________________ 宗教信仰/religion_______________________
现职业和工作单位/current employment & employer
_____________________________________________________________________________
联系地址/present address ________________________________________________________
邮编/zip code_____________________________电话/tel_______________________________
传真/fax_________________________________ e-mail________________________________
2.受教育情况/educational background
学校institutions _______________________________________________________________
在校时间year attended(from/to) __________________________________________________
主修专业fields of study ________________________________________________________
所获文凭diploma received ______________________________________________________
3.语言能力/language proficiency
英语english:_______________________________
汉语chinese: ______________________________
其他 others:_______________________________
4.来uec学习计划/plan of study in uec (please click what you plan to study)
1) elpc/英语熟练课程 □ 2)piec/优质强化的英语课程 □
3)toefl/托福课程 □ 4)customized communication course/定制的交流课程 □
2)申请学习时间/ duration of specialized study:
自/from________年/year_____月/month_______日/day
至/to _________年/year______月/month_______日/day
3)在uec的详细计划(请另附纸张)：___________________________________________
5.申请人保证/i hereby affirm that:
1)上述各项中所填写的内容和提供的材料真实无误;
all information and materials given in the form are true and correct.
2) 在美学习期间，遵守美国的法律和法规，不从事任何危害美国社会秩序的，于本人来美学习身份不相符合的活动;
during my stay in usa, i shall abide by the laws and decrees of the american government, and will not participate in any activities which are deemed to be adverse to the social order in usa and are inappropriate to the capacity as a student;
3)在学期间，遵守学校的校纪校规，尊重学校的教学安排;
during my study at school, i shall observe the rules and regulations of the uec, and will concentrate on my studies, and will follow the teaching programs made by the uec.
申请人签名/signature of applicant__________________
(无此签名，申请无效/the application is invalid without signature)
日期/date _________________
注意事项/important notes:
申请人须用中文或英文印刷体填写，其他文或缺项填写的申请表无效;
this form is to be completed by the applicant in chinese or english only. an incomplete application or application completed in languages other than chinese or english will be invalid.
预祝您申请成功!
we wish your application success!