E4, I ]. , ZE=E ?: EE NRE FLII
€+l*+ll
trhrtAJ. t+ l+Ie I L3SrJf ,J+i
C202t-202
Slr
l-,r+
&+ti" ep +l
L$idl eLlt _j.b!
4r&
D
J/1?4.Lt,78?E
9IEEd 0i+sl-ill sljF,ll Lltll
cJ$ .t" L$ eLlt -rt!l i i
il_l^ sio I l+*Jil d!l-
Ltl i.E $.
i .J+i
LJ,..oo.tlJc'l f
frt -l+\ l;le C
I Eli UEJ'J Y-l I
d-rir.-ll if
n4/
I liA
Jr ir+ti.
L sS-lt
lJ clE+€Jl
J! zot+
_,t_ll
$-,\1 j
.q+tiiJl_,
;j-J,J+l
drL.rly i
(c
drt*,|;.r i
clp
,-r4JjJ.,=Jl L
dl+.,:Uill
,fllFl
rJa i.#+-ll ;
i,!1,r. -, l+1r; i f'll dH,Jl e;;_ir-+3 1958 *r++',+l lfl
e4J*t.oA.l trl.!)rJ g
*r|S C q+J.'l dF lrol.o,'..od.rL$)r.ll
JJlt lE, o: d*.ii .#d+ll
L"iLL,i
4+++fi1_.Ji*.,1cll$['ll eri J qtJL,4igYl g3L:Jl
ubJtll kr*. 4 iJl l!.iii!! .r=i o;
'e'-.'11.9 CLJI ft JJi u o! +ct-lt t a*i)* Ii** rii,r. Il
"oril*,,!lt) J$bll +r' i1,lr elt* c(ol;
oiS-r;'"ll ,r_;rli^ll) *!
ji ,,'tut! cs4 c+l
-"Sall .J$ ,-n L.i
cJ+ .t^ LrLII ,^:.lt I dr6 ,jo L r[ ^ll . tt.:
.1.ALalJ du !ra.a. {l*-a..t
tu rJ
E)J"yl os4i g; i'Yl ei"ll AflJ i
I gl-."tJl., L,.- tp-r;Kllt ilr'.ll
cj+ ct k€tr ;5+ .,:ll cll q.t*ll
,Ssll i=i. Cf )J
tn,_--,,.-oi--1,c-rlttt
I . t :r t i
|
,4Jat _J t+je L
E :i/t9
rl r tt I i .
Jil J+J r+l}
iLJl
4-{l-61ji"
drJ ql"i $3
l_.dtt 6_gt*r
i; o-FJl
cllt.,'3lt .+"j--l r*o d UJlr5JI
I _Sj
,t ,n-,U; !b
yl d+-* u^ Ji
l_;a 6,tc J+-il
'dJl : !b
l,rttLJl
I lia ,j.J"+
L.i .a+jS-Jr.oll
l-# L^-tXl I llA c,jr-rli
1# qJalil
;l +aU^ q[l
.i*,'l;:Ji 6 J diSill 4S
qJJq (f i dl* 6!* lrS_r
# ++.Sl ,"#
i.lc*"il| #
LJ,SIJI .j+ ,,r. Lri
Cftill ri.r'*"l I
11i
;lsj"cJt gn
6tljl 4+*l! 4i- 35 d
tjl fu.,.rill+ ej-,40
D 6/rE lllll
t e-+j^11
d^^?,1I os +tJH)l
,rJri 400 elldjt !S**
r6ul Cl,llt /1
J;hj ?E 12
Jlhs fr' /3
Z4.tL,ZEPE lrOE
tlFEn r/Ie
lllllllllla;U -,+P dJ+sill
dJ esj4ll
.1-o6rEi et;'lt
httns:/l inchina.csc.edu cri#ll 1n
.++-l q;-.;Yt ;r;c
tri+
11[ cJYi iJs. ;39
_,rlt d_,rll A+_l
crU!;Jl cjti:l - Ag;ency n
bJ14 a.-.tJl
4=rl.(Ar+-*Jt
."Jc, +-l53 +tltJ.ll LaJE+;-,
43i;n-e
c,sy)
i4+jc+Yl i '+r;, Jl ,jt+tiXt+
iJ d!F^,nlt >
cj++',,:lt >
+ 01 ct*
,-;+F
r"tJ
.rpSlJ.Jl i_tl>
lcJlA il^
*L q*iu
'"Fl+ >
(}^, -iU
)f I d,s{ >
iJrJ. ll
ions.html?
==o/oJCYo7C.
+ +#:lt *t -$11
.L*HII; Lr-*-iill
CdrSiIl>
clJi_r
l.-lJJl # tJi$l_il| i I .J;i*+ F
cal-.Lrt Jt .-r,_l5
,,r$1el'.l,ij ql+,Jt e+
lrj$yl q;;Yl ;
cF l,r"JL 31 *tJ c+
triilt _,E+.11 -*rItJ"Jl
o+ll J$ la_.,h::l u+
ber .- gL**t+ll yl it/l .,ID t)l!)
,ir:qip-I cit -\Jl
I i"..ol+.ll &i rJ .+i-'l;r d.++ frll
Xl tFJp r"b t
:oJEJt l+l-il cDi
.ors/universities/
t. 'i 'l . - 1
Jlrrl
ola-uu luc
a=UI ,riIl q'-i
*JJ a;*',-y
iol
ctJ$44
l. 4 r.
,rJl a.rlu-,1 I
i^+-r+ #iii-JF.
JiS$t ,,/ d"+*iJl
i*=j'11; i$a.$Jl
.jl trl!,ilJl s:Li*
iLlJJl e+.;i; gl r,^tt4l
I d .l .ti
+; Cl -)i*ti arl$
61J-.a:g;l.rJ e*_pll qW
qF *l+Jl
lJ J.t-i:Jl ,-iJ*iS
6_pli*3 qjl
00 *jl3*; i
u B/13
lllillllldiirSJt
highest diplomarr {1lrL#.111 /t
r.F;'i;
I # c!+rll u+
ClJil er*.ilL
lJ LJ"]L4X| ./. 0c, 43."i
I dr+tljl 4-ult, iYl edlr
,rJc i-Ett -*ll # Ol ailVl gi"
+-fl-,+Jl l';1-,;tJl I lll 6Jljr
le.}-Jl # d+-".11 i.F*J
iill *i cJ+-,"
11 .-, -.ilJi*'Ul
p.ti3 cj)i r-,.
olU:d
a.t\,,lJt *:r ,t..--:.*
Academic transcriptsrr ristr tl
e.-Lill lLiill ,-i
r'
4+ 'Hliiyl eill
Ltirl,.-.ll # Ci Yl u.
I
4++,_.'lJl g3j',i'lt i_; J-t
racgy.s
iY t 4-illl+
, r'^ rll g3 JJJil #.
Jttrrq
r 4+re u.r++
4+TS 11 TOE qjS4 elE TS ;1 TOEFL , il< Jl
cr_
uL'.o dtr i
;t$il
i"3q'iJl I
J,'i 6Lil+,ll
ilt 4i{JI+ +*1;$l .# q
r-13*
L; Uli iYi 4illl i
6.tLc.i .'Jc, ., '\![!f 6
:l4+il=i. . ylailll #
ilj+ll crt*it+Jl 0c
Erll +-r-.':SJYI iy'l
gl.b=;+,L trLe ,'H* .!
n
1El lsllllilllllllllilll-,r+gilt #Ull
.SLiJl 6.rkj ip
p,r, iJL= *s
t
6rt4.i dt"j
eliJJt #
r).tyl (5+i
#tijl {.l*
\+brYl dJ+,-5Jt
e-riS.of l
'd:rlt
ClJirll
iHii,..!i €s eti
lLri _r* Clli_l
dJr--lli:$+
A,I-rii 0l + ct
I r*r l.€.I;.=l ,{
"jJl 6Jrsr.ll #E-ell+ ai
r|+j.l icr a,-h
q/rrElyl ir"ll
e)|:r*Y 4.};i Fl
n tL/La
[Jl-oi-Yl .J--fi
tJ. .++_rjSIYl
"Lr,i\+Ttarltll
Ll.tyl .r+-JJ
.iilg
cjh*l+ll +lni
E4, i_ r. , zE=E 3 i
EE
t'lFEdJ+*tll Lui-ill
*++ I #,;FrrYl r;ia Lluf #rl. Jt *l.b.:
t+ or cr ful+ lgsgln 4*a;l 'l ;4* Cif+..rfll
X*I ,$ti 4y"*Yl
1d d+i cF €JJs
ii Of ghl r it^tl ,.
sl
,*".f1
L.i.t+o
r0
E
1EllellllllllllllL-;sl+j,fr i;lJl+)
hl-ru
Cilt enu;+l
://www.cam schina.o
4+.b-rYl ts
,cn/#llosi
ru.tli j$r p ils3 7 4779
r,hrf
ions,html?
"=Vo7CYo7C
.caln
A'.till ++,#
inchina.csc.e
i.lt iln !1t i't*ll
(4J.."jJirlt iillt+)
.calmpusc
i^ll ir Srtii*rll
i+iJ,4lf *rtr*lill
.carnt)uschi
l++1" reJli Ct
Cuniversities/
=4,ll,EEEE =;EIFJ flFE FLlr
Agency Number -
10001-
Peking Uni 1OOO2 _ RENMIN UNI1OOO3
-
TSINGHUA U10004
-
BEtJING1OOO5
-
BEIJ1NG UN 10006-
Beihang Univ 10007-
Beijing Insti10008
-
Univ.of
10010
-
Beijing Univ.10013
-
Beijing Univ.10019
-
China Agricul10022
-
Beijing10025
-
Beijing Un10027
-
Beijing10028
-
Capital Norm10029
-
Capital Instit10030
-
Beijing10031-
Beijing I10032-
Beijing Langu 1.0034-
Central Univ.10036
-
Univ. of I10038
-
Capital Univ, 10040-
China10043.- Beijing Sport 10045
-
Centralt0Q47
-
Central 10049-
The Central 10050-
Beijing Film 10052-
Central U10053
-
China10054
-
North China10055
-
Nankai Unive 10056-
Tianjin Univ"10057
-
Tianjin Univ.10062
-
Tianjin Med10053
-
Tianjin Univ.10065
-
Tianjin10066
-
Tianjin Univ.10058
-
Tianjin Foreig10140
-
Liaoning U10141-
Dalian Univ.10145
-
Northeastern10151"
-
Dalian Mariti Univ.itv
of llhe Un
RS|W OF Cr{tNA IVERSITY
UNIVERSITY RSITY OF]IECHNOLOGY (BUAAI
te of Techrrology
and Technology Beijin ChemicalTech.
Posts and Telecom ral Univ (:AU)
Univ.
of Chinrese Medicinp
I Univ, Univ,
e
of
Physir:al Educations Studies Univ'ersity ionalStudies Univ.and Culture Univ.
Finance ancl Econom nal Business and Business and Econom Affairs Univ.
niversity of lvlusic of Fine Arts demy of Drama
my
For Nationalities of Political Science a
Power University
Science and Techno I Universit'y
Traditional C:hinese Me
I Univ
Technology and Educati Studies Univ. (TFSU)
Technolo6ry
/Embassy
rons
Law
tctne
n 14l1q
E4, I ]. , EE=E S i EIE I"IEE FLE
1-0159
-
China Med10161-
Dalian Medi 10165-
Liaoning10166
-
ShenyangLOt72
-
Dalian Univ.10173
-
Dongbei Un10183
-Jilin
Unive10184
-
Yanbian Uni 10185-
Changchun10200
-
Nonheast10201
-
Beihua Univ.10203
-Jilin
Normal10210
-
Heilongjiang 7A2LZ-
Heilongjiang 10213-
Harbin Instit4277
-
Harbin E10222-Jiamusi Uni t0224
-
Northeast10231-
Harbin N 10246-
Fudan Univ, 10247*
Tongji Univ.70248
-
Shanghai J10251
-
East China U10252
-
Univ,of
10255
-
Donghua Un10258
-
Shanghai10269
-
East China10270
-
Shanghai10277
-
Shanghai70272
-
Shanghai Uni 70277-
Shanghait0278
-
Shanghai Co10280-Shanghai Uni
tO284-
Naniing Univ 10285-
Soochow10286
-
Southeast U10287
-
Nanjing Unlv10288
-
Nanjing Univ10290
-
China Univ.10294
-
Hohai Unive10295
-
Jiangnan10300
-
Nanjing Univ.I University
I University mal Universitv
mal Univerrsity Foreign l-anguages
of
Financo and Economi risty. of Science and T Univ.
University of Technology ering Univ.
riculture U niv.
University
Tong Univ,
iv, of Scier ce and Tech for Science and T . of Traditional Chinese
Un iverrsity I Univ.
tionalStudies Univ.
. of Finance and . of Sport
orf Music
of Aeronautics and As
of Science and T
Mining and Technology
of lnformationr Scien ce 10307
-
Nanjing Agri Itural Unirr'er.ritvTech.
logy
(suFEl
utics
f'l 1=/1q
Z4.LL,EEEE 5iEE llRE FLlr
1.0315
-
Nanjing Un10335
-
Zhejiang 10337-
Zhejiang10338
-
Zhejiang Sci10345
-Zhejiang
10355
-
China AcL0357
-Anhui
10358
-
Univ.of
10359
-
Hefei Univ,10370
-
Anhui10384
-
Xiamen Un10403
-
Nanchang10408
-
Iingdezhen70422
-
Shandong10423-Ocean Un 10445
-
5handong10459
-
Zhengzhou10486
-
Wuhan Uni10487
-
Huazhong10491-
China Univ, 10497-
Wuhan Univ10504
-
Huazhong10511
-
Huazhong N1052CI-Zhongnan U X0530
-
Xiangtan10532
-
Hunan U10533
-
Central Sou10542
-
Hunan10558
-
Sunyat-Sen10550-shantou
U 10561-
South China10564-South
China 10572-
Guangzhou10574
-
South China10593
-
Guangxi Unl 10598-
Guangxi10602
-
Guangxi N10608-Guangxi Un 10610-Sichuan Uni
10611
-
Chongqing iversityof Chineser Medicine versity
v of Technology Tech Univ,
lUniv.
of Art ty
and Tei:hnology of Ct
Technology Univ.
ic Insltitute versity
rsity of China I Universlty
n iversity sity
of Science and Tech Geoscience:i (Wuhan) of Technoilogy
icultural Llniv.
University
iv.
of
Econ ornics and Lavr, Changsha Universitl,, Changsha I University, Changsha niversity
rsity
niversjty of Tech nology Ituraluniversity iversity ol' Chinese Med
rrnal Uni'yersity
ty
ical Univerriity I University
rsity
for
Nationalities itvina (USTC)
cine
fl
1E,/ 13E4. I ]. .
ZEEE
9:EE
t'lFE I]LE10613
-
Southwest10614
-
University10617
-
Chongqing10635
-
Southwest11646
-
Ningbo Un10651-
Southweste 10657-
GUTZHOUtO673_YUNNAN U 10674
-
KUNMING10681
-
YUNNAN N10689.YUNNAN U 10698
-
XI'AN J10599
-
NO10701
-
XTD|AN U10710
-
CHANG'ANIO712-
NORTH 10718-
SHAANXI NLO724
-
Xt',AN I1073C
-
LANZHOU10731-
LANZHOU 10732-
LANZHOU J10736
-
NORTHWE10749
-
NINGXIA UN10755
-
XtNJ|ANG107s9
-
sHrHEzt uN10760
-
X]NJIANGT0762
-
XiNJIANG10384
-
XIAMEN UNng University Electronic Science and niversity o1' Posts and niversity
University
of
Finance a IVERSTlYIVERSITY
IVERSITY lCF SCIENCE RMAL UNI\/ERSITY
OF FINANCE &
G UNIVERSITY
RN PLOY-TEI:HNICAL U RSITY
Nrvf Rstw A&F UNIVER.SITY RMAL UNIVERSITY
TIONAL$TUDIES UN
IVERSITY
IVERSIW OF'TECHN G UI{IVERSITY NORMAL IJNIVERSITY
RSIW
T UNIVERSITY AL UNIVEIRSITY RSITY
nology
of
China municatirlnsd Economics
D TECHNOLOGY
NOMTCS
RSITY
D
1?/15E4"II,ZEZE
9;EE
t1f,E fiLlj,IEA
FOREIGNERPIIYI
ffitr8#
EXANIINA1IION FORM
KE
Nanre
rle msle
S& HH
Birthday
HflH
ffiil#ftdts&rFF)
photo (!itamped Offrcjal
Stamp)
t[#iif,fi,fi
Present mailing
ht'-
ddress
E,#frHtr
Nationality (or Area)
il'1ftil
Birth place
fr4
Blood typc
#W +frX
rYpld./tffiHff
Poli,F ffi
DiplIE tl #+
ScarEl F #+
Retafr+ft.frfi#
ffi{i,t*f&#trH4
rt*EffHffiTll#ffi'
Have you ever had (Each item musr I rs
fuvcr
ElNo EYesrnyelitis
[]Nro EYesheria []No lYes
:t
fever
flNo, trYes 'sing fcvcr[]No
EYesTyphoid an,d paratyphoid fe Epideruic c:ercbrospinal met
:efitrEHEl# "' ' fi "8")
ny ofth€ follorving diseases'/
e answereel'*Yes" or "No")
H fi
Bacillary dysente4#fttTHtfi
BruccllosisH+&tffr
Viral heparitisPffiH#6#
puerpcralstrcptocc6tr*
'er flNo lYes ingitis flNo
ilYesnNo
IYesllNo
EYesnNo
nYes'crr$ infbcti,on
nNo
[.]YesE6f
Do you have (Each item mus
+ffirH
#r#Hfir
#l#tfi
PsycHTF\fE&"'/a\J+#Ffi*4
ny of the following diseases c be answere.d "Y)s" ot "No")
Toxicomania- Menta,l confusion','.., osisr
HfiEU
Manic paycFldlil
Psranoid psAlftflU
Hallucinatoflttfrlff' t$frEffi]HFt# "8"
Edisorders endangering rhe public ort
'tE"
)rr and gecurityT
lNo
FYeslNo
QYeslNo fl'es lNo
lYeslNo
EYesFH
Height
E#
CM
i4E
'Weight
Eft
Kg
ME
Blood pressu
#fl(fr&
mmHg
HHllltt
Development
H#IHJff
.Nourishrnsrrt
fi#
Ncck
mh 1;L-
Vision fi R_
Conccbed rFFrEi4i visiEL_-
)o
fi R__-=--
Eyestr
W€.fi
Colour sense
,8tr
Shin
#E#
Lymph node
4
Ears
.H IrIose
ffiviDt+
Tonsils ,[r
Heart
trf
lLungs
ffi#
Abdomen
n
1!=t/1t
E+,I1,EtrEtr
Othcr abnormal fiudi
ffIffiXfr fi!€ffiR (ftf&€ffif,-+)
Chest X-rav exam (attached chest X
report)
{r-&g&H (affiE&H.
ffi++fr.i#+&A)
Laboratory exam (attachcd test report AIDS, Syphilis etc)
+EYTE[E'-F-r!l&E following diseases of di
Chole,ra Yello,ry fever PIague.
Leprcsy
ffififiH4\*€HFt#ffi,
found during thc prcsent e
#rffi
Venereal DiseaseHF#&,
LungtoberculosisJ{#fi
ArDstffiiltffi
PsychosrsE[fi#?.
Signnture of physician
ffi€4,filH+
Official Stanip