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国际中医药教育师资培训班申请表
2017-09-05 10:41   审核人:

Seminar on International TCM Education

APPLICATION FORM   

照片

Photo

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1. /Family Name ___________________________________________

/Given Name ____________________________________________

护照用名/Passport Name_____________________               

2. 国籍/Citizenship ___________ 护照号码/Passport No.____________

3. 性别/Sex          □男/Male              □女/Female

4. 婚否/Marital Status  □未婚/Unmarried       □已婚/Married

5. 母语/Native Language_____              宗教/Religion____________________________

6. 出生日期/Date of Birth: /Year_______/Month_______/Day_______ 

7. 出生地点/Place of Birth: 国家/Country:_____________   城市/City:_____________        

8. 永久通信地址/ Permanent Address                                                   

电话及传真/Tel and Fax_________________________________________                 

电子邮件/E-mail_____________________________________________________________   

9. 健康状况/Health Status ________________________________________________________  

10. 语言能力/Language Proficiency:

汉语/Chinese:  很好/Excellent: 一般/Fair:  不会/Poor:

11. 受教育情况/Education Background:

学校                在校时间             主修专业          毕业证书及学位证书

Institutions           Years Attended          Fields of Study     Certificates Obtained or

(from/to)                                     To Obtain

                                                                                     

                                                                                  

                                                                                                                                     

12. 工作及教学经历/Employment &Teaching Record:

工作单位            起止时间              从事工作             职务及职称

Employer           Time (from/to)          Work Engaged           Posts Held                                                                                 

                                                                                     

                                                                                  

                                                                                  

13. 曾发表的主要学术论文、著作及作品/Academic Papers, Writing & Art Works Published:

                                                                                                                   

                                                                                                                                

                                                                                

14. 备注/Remarks

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

 

15. 申请人签字/ Applicant’s Signature

 

 

联系人/Contact: 李海南/LI Hainan  聂静怡/NIE Jingyi

中国 天津市南开区玉泉路88 天津中医药大学国际教育学院,邮编:300193

International Education College

Tianjin University of Traditional Chinese Medicine
88 Yuquan Road , Nankai District, Tianjin , P. R. China, 300193

联系电话/Tel: 86-22-59596555,86-22-59596177;传真/Fax: 86-22-27374931

电子邮件/E-mail: tutcm@hotmail.com

 

Notice:

请用中文完成此表格并发送电子版至tutcm@hotmail.com

Please fill in the form in Chinese, send the soft copy to tutcm@hotmail.com

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