中文姓名/Chinese   Name (if any):

国籍/Nationality:   

性别/Sex:   □   男Male      □ 女Female

出生地/Place of   Birth:

婚姻状况/Marital   Status:

□  未婚Single   □ 已婚Married

出生日期/Date of   Birth:

Year:      Month:    Day:

护照号/Passport   Number:                          有效期/Passport Valid Until   Year:     Month:     Day: 

通讯地址/Detailed   Postal Address (including post code) which the admission documents are to be   sent to:

电子邮件/Email:

电话/Phone:

学历/Highest   Education Level:

职业/Occupation:

单位或学校/Name of Employer or   School:

汉语/Chinese   Level: □零起点/beginner  □初级/elementary    □中级/intermediate    □中高级/good     □高级/advanced

学习身份/Status: □语言生/Chinese   Language Student   □本科生/Undergraduate     □硕士生/Master     □其他/Other

专业/Major of   Study at TUT, China (None Chinese Language Student):

学习期限/                自        年    月     日 至       年    月    日

Duration   of Study at TUT:  From Year     Month       Day       to  Yea       Month         Day  

住宿要求/Dorm   Reservation: Refer to the page of “Expenses” on our website and mark your   room preference below. (Note: The choice of rooms is on a   first-come-first-choice basis.)

□   学术交流教育中心（留学生宿舍）/ Academic   Exchange Center (International Student Dormitory)

□   双人间 Double   Room   长期long –term   (4 months or above) students：人民币45元/天/床 RMB45/day/bed；

短期short–term (below 4 months) students：人民币50元/天/床 RMB50/day/bed

经济来源/           □   奖学金/Scholarship   (if yes, specify source):

Source   of Funding:   □ 自费/Self-support    □   其他/Other

推荐单位/Recommending   School or Agency (if none, fill in “self-reference”):

在华担保人/Guarantor in   China (If any):  Name               Phone                  Email

你是如何得知我们学校的/Where did   you hear about our university?

□   Google     □ MSN   □ Yahoo   □ 中介/Agent   □ 学校/School   □ 亲朋/Friend/Relative     □ 其他/Other

申请人保证/I hereby   affirm that:

□   上述各项中所提供的情况是真实的/All the   information in this form is true and correct.

□   在中国期间,遵守中国的法律和学校的规章制度/I shall   abide by the laws of China and school regulations.

□   接受天津理工大学对本人在华学习的安排/I accept   the arrangements of TUT regarding my studies in China.

日期/Date:                                   申请人签字/Applicant   Signature: