国籍/Nationality

护照号码/Passport №

性别/Sex

婚姻状况/Marital Status

宗教信仰/Religion

出生日期/Date of Birth

年/year        月/month      日/day

(format: yyyy-mm-dd)

出生城市/City of Birth

国家/地区/Country/   Area

境外地址/Overseas Address

录取通知书和JW202邮寄地址/Address   for Mailing the JW202 or Admission Letter Documents

Tel/Cell                                               E-mail

教育情况/Academic Degree   Acquired

职业/Occupation

工作或学习单位/Company or School   Name

学习类别/Type of Study

□ 长期进修生/Long-term Study    □ 短期进修生/Short-term Study     □ 其他/Others

学生来源类别/Student’s Source   Status

□ 奖学金生Scholarship   Students      □ 自费生Self-supporting   Students

预计学期期限/Tentative Length   of Study

从/from         年/year      月/month    日/day     到/to        年/year       月/month     日/day

在何时何地学过中文，学了多久？/Where and When   have you studied Chinese, and How long?

请选择学习方式/Specify the Way   of Study

□ 班级/Group   Class  □ 一对一/One-on-One   Study   □ 一对二/One-on-Two   Study  □ 其他/Others  

评估自己的汉语水平Self-estimated Chinese   Level

□ 入门/Beginner        □ 初级/Primary             □ 中级/Intermediate    □ 高级/Advanced

紧急情况下联系人姓名/Name(s) of Person   for Emergency Contact

姓名/Name                                          Tel/Cell                        

是否已购买在华意外伤害保险？/Have you ever   bought any safety insurance during stay in China (including accident injury)?     □ 是/Yes     □   否/No  

申请人保证：

1．我所填写内容都是真实准确的；

2．在北京开放大学学习期间，我遵守中国法律和北京开放大学的各项规定。

I   hereby affirm that:

1)   All the information in this form is true and accurate;

2) I shall abide   by the laws of the Chinese government and the regulations of Beijing Open   University during my stay here.

申请人签字/Applicant’s   signature                                   日期/Date

注意：

18岁以下入学需提交监护人公证书；60岁以上入学需提交中国驻外使领馆认可的医疗机构开具的健康证明。

Attention:

The Guardian Attorney Letter   is necessary for applicant under the age of 18, the Health Certificate issued   by medical institutions under the authorization of Chinese embassy is   required for applicant over 60.