齐齐哈尔大学外事处暨国际交流学院

* 注： *必填，如果没有信息可填请填写无或ＮＯ。

中文姓名：	*	Surname:	*	Given Name：	*
国籍/Nationality:	*	护照号码/Passport Number:	*	性别/Sex:	*
婚否/Marital Status:	*	出生日期/Date of Birth: Day 　Month 　 Year	*	出生地点/Place of Birth:	*
联系电话/TelephoneNumber:	*	通讯地址/Mailing Address:	*
最后学历/Highest Academic Degree Obtained:	*	汉语水平/The Level of Chinese:	*
来华学习专业/Field of Study in China:	*	学习期限/Duration: from Mo. Yr. to Mo. Yr.	*
学生类别/Student Status:	* 1.普通进修生General Training Program;2.本科生Undergraduate Program;　3.短期生 Short-term Training Program.
经费来源/ Source of Funding:	* 1.自费/Self-supporting; 2.其它/Other;.
入学前职业/Occupation before Studying:	*	入学前所在单位/Unit before Studying:	*
推荐单位或个人及电话号码/Reference and Telephone Number:	*
在华事务担保人及电话号码/Guarantor in China and His/Her Telephone Number:
家庭主要成员/Family Members
姓名/Name:	与本人关系/Relation:	职业/Occupation:	联系电话/Telephone:
*	*	*	*
*	*	*	*
以下内容由留学生办公室人员填写 The following should be filled by teachers of Qiqihar University.
护照号码/Passport Number:		护照有效期限/Date of Expiry: Day Month Year
签证种类/Visa	1.X visa ; 2.F visa ;　 3.L visa ; 　4.其它/Others;
居留证号码/Foreigner Residence Permit Number:		居留证有效期限/Date of Expiry: Day Month Year
备注/Remarks:[请注意适当使用Enter键来换行]

Add: Foreign Students Office ,Internaional Exchange College, Heilongjiang University No. 42 , Culture Street, Qiqihr City, Heilongjiang Province, China Tel: +86-452-2738259 Fax: +86-452-2712809 Postcode:161006 E-mail: luzheng4976@126.com

联系电话：0452-2738259