丽水学院国际学生入学申请表(2026 版)
Lishui University Application Form for International Students2026 version
Family Name: Ahmed First Name: M Shamim Middle Name:
N/A
Chinese Name: N/A Married
Sex: Male
Single
Date of Birth: Place of Birth: Bangladesh
(Y) 1999 (M) 02 (D) 27
Photo
Nationality: Bangladeshi Passport No: Passport Valid Until:
A12041607
(Y) 2033 (M) 10 (D)25
Religion: E-mail Address: [Link]@[Link]
Native Language: Bengali
Islam
Permanent Home Address & Tel: Chaugachha, Niribili Para, Chaugachha,
Chaugachha - 7410, Jashore, Bangladesh
Tel: +8801791436262
Family information
Father: (name, age, ID/passport number, email address, career and working status)
Name: MD. Khabir Uddin, Age: 67 Years, ID No: 8247820163 , Working status: Businessman
Mother(name, age, ID/passport number, email address, career, and working status)
Name : Minu Begum , Age: 57 Years, ID No: 1472406873, Working status : Housewife
Other main family members, if have:
Education Background:
Major
Name of School /College/University (From: M/Y) (To: M/Y ) / Degree obtained/Year
Chowgacha Sahadat Pilot Science 01/2012 02/2014 S.S.C. / 2014
Secondary School
Chowgacha Degree College Science 04/2014 06/2016 H.S.C. / 2016
Bangabandhu Sheikh Mujibur Mathematics 06/2017 06/2023 [Link]. / 2023
Rahman Science and
Technology University
Work Experience (to the time of application):
Employer Time (From / To) Work Engaged Posts Held
Ashiq Impex Ltd. 06/2025-present Corporate Sales & Senior Executive
Marketing
The Chinese Language Proficiency:
Excellent Good Fair Beginning
(Chinese proficiency test/HSK):
HSK____/Yes, band____. /Yes, but no grades /No
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Applying:
Foundation Program
Bachelor ’ s Degree Programs Master ’s Degree Programs
Field of Study in China (Degree students Only):
Bachelors Degree Programs:
Nursing Science Computer Science and Technology Civil Engineering
Electronic Commerce Tourism Management English Language
Horticulture New Energy Materials and Devices
Master’s Degree Programs:
Master’s in Agriculture Master’s in Materials and Chemical Engineering
Master’s in Resources and Chemical Engineering
( In the event that your chosen major
does not reach the required number of students to form a class, do you agree to be placed into a closely related
field of study? Yes No)
Intended duration of study: from Year Month to Year Month
Name, address & Tel of the person or agency to act on your
behalf in China:
Source of Funding:
Self-supporting Scholarship Other
I hereby affirm that:
1.
All information and the provided documents in this form are accurate and true.
2. During my study in China, I shall abide by the laws of the Chinese government and the school’s regulations.
: _______ ______ ______
Applicant’s signature: --------------------------- Date: YYYY MM DD
注意事项 Note:
1.
The application is invalid without the applicant’s signature.
2.
This form is to be completed Chinese or English (print) only. An incomplete application or complete in langu
3.
An incomplete application form or failure to submit supporting documents WILL DELAY the process of your
健康信息声明
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Health Information Declaration
目的：为保障您在校期间的健康与安全，并协助我们为您提供可能需要的适当支持，请如实填写以下健康相关信息。所有信息将严格保密，仅用于健康服务与
风险评估。
Purpose: To safeguard your health and safety during your studies and to help us
provide you with appropriate support if needed, please accurately complete the
following health-related information. All information will be kept strictly confidential
and used solely for health services and risk assessment.
需披露的健康状况（请勾选适用项）
Health Conditions to Disclose (Please check as applicable)
◻ 哮喘 / Asthma
◻ 糖尿病 / Diabetes
◻ 心脏相关状况 / Cardiac-related conditions
◻ 癫痫 / Epilepsy
◻ 精神健康状况 / Mental health conditions
◻ 结核病 / Tuberculosis
◻ 活动性肝炎 / Active Hepatitis
◻ 其 他 严 重 或 慢 性 传 染 病 （ 如 疟 疾 、 水 痘 等 ） / Other serious or chronic infectious diseases (e.g.,
Malaria, Chickenpox, etc.)
◻ 其他可能影响学习或日常活动的长期健康状况 / Other long-term health conditions that may affect
studies or daily activities
◻ 无上述状况 / None of the above
补充说明（如需要，可简要说明已稳定控制的病情或具体状况）：
Additional Notes (If applicable, you may briefly note conditions that are well-managed
or provide specifics):
____________________________________________________________
重要须知：
1. 如实披露：准确披露健康状况有助于我们在紧急情况发生时提供及时、有效的协助。隐瞒可能严重影响学业或社区健康的重大病史，可能导致入学资格被
重新评估，或违反学生行为守则。
2. 支持与服务：披露信息不会影响一般的入学评审。我校健康中心可为有需要的学生提供基础医疗咨询与转介服务。
3. 保险与既往病史：所有国际学生必须购买学校指定的来华留学生综合保险。请注意，对于在本声明中披露的或已知的既往病史，该保险可能将其列为除外
责任，或不予覆盖相关治疗费用。
4. 责任与费用：学生需对自身健康及医疗费用承担最终责任。所有医疗费用、因健康原因产生的相关责任以及因保险除外条款产生的费用，均由学生本人承
担。
5. 政策依据：具体的健康要求、保险规定及因病休学/退学相关学籍与签证管理办法，详见我校《》及相关规章制度。
Important Notes:
1. Accurate Disclosure: Providing accurate health information helps us to deliver
timely and effective assistance in case of an emergency. Concealment of significant
medical history that could seriously impact your studies or community health may
lead to re-evaluation of admission or constitute a violation of the student code of
3
conduct.
2. Support & Services: Disclosure does not affect general admission evaluation. Our
University Health Center can provide basic medical consultation and referral services
for students in need.
3. Insurance & Pre-existing Conditions: All international students are required to
purchase the university-designated or approved Comprehensive Insurance for
International Students in China. Please note that pre-existing conditions disclosed in
this declaration or otherwise known may be excluded from coverage, or related
treatment costs may not be covered under this insurance policy. It is the student's
responsibility to review the insurance policy terms carefully before purchase to
confirm the scope of coverage.
4. Responsibility & Costs: Students are ultimately responsible for their own health and
medical expenses. All medical costs, liabilities arising from health conditions, and any
expenses resulting from policy exclusions are the student's personal responsibility.
5. Policy Reference: For specific health requirements, insurance regulations, and
policies regarding medical leave/withdrawal and visa status, please refer to the LSU
International Student Handbook and relevant university regulations.
申请人承诺
Applicant's Declaration
本人声明，已阅读并完全理解上述全部须知，特别是关于既往病史可能影响保险覆盖范围的条款。我在此所填写的健康信息是真实、准确的。
I declare that I have read and fully understood all the above notes, particularly the
clause regarding how pre-existing conditions may affect insurance coverage. The
health information I have provided here is true and accurate.
我理解并接受，若因本人提供不实健康信息而导致任何风险或后果，或若已披露的既往病史所产生的医疗费用未被保险覆盖，本人将承担全部相应责任。
I understand and accept that I will bear full responsibility for any risks, consequences,
or medical expenses related to pre-existing conditions not covered by insurance,
arising from the provision of inaccurate health information.
申请人签字 / Applicant’s Signature: _________________________
日期 / Date: ________ 年 / Year ______ 月 / Month ______ 日 / Day