1
APPLICATION FORM FOR INTERNATIONAL STUDENTS TO STUDY AT NANJING COLLEGE OF
CHEMICAL TECHNOLOGY NCCT
. Please fill all the information requested. Handwriting is not acceptable. Please write None if not applicable.
Name
(as shown
on passport)
Last/Family Name
Photo Given Name
In Chinese
! "
Nationality
# /Male %
&/Female %
'(/ Single %
)(/Married %
*+,-
eligion
./01
!ate o" #irth
2/Year 3/Mon 0/Date ./4
Pla$e o" #irth
!5/Co%ntry
67/City
89:;<=>?@A
Permanent &ddress and 'el( No(
!5/Co%ntry 67/City
BCDA/Postal Code ) >?/'el( No(
EF:;<=>?@A
C%rrent address and 'el( No(
!5/Co%ntry 67/City
BCDA/Postal Code ) >?/'el( No(
! #$%&' #()*+&'
Please send mails to* Permanent &ddress C%rrent &ddress
GH@A
Cell phone N%m+er
>IBJ
,-mail
KLMN
.ighest ,d%$ation
O@A
Passport No(
OP1
/alid %ntil
2/Year 3/Mon 0/Date
MQRN
cademic !nformation
STMUV
Name o" .ome 0niversity
STWX
Ma1or at .ome 0niversity
YM01
,ntran$e !ate (yyyy/mm/dd)
STZ[
N%m+er o" years enrolled at home %niversity
\]^_
"hinese language
proficienc#
\]MQZ[`a bc3
a bMonths o" Chinese St%dy
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#and o" .S2a'est o" Chinese Pro"i$ien$yb`a bGrade
or other $erti"i$ates whi$h $an show yo%r Chinese pro"i$ien$y
1( Spea3ing
lNone % mn#asi$ %opIntermediate %qrFl%ent %
4( Listening
lNone % mn#asi$ %opIntermediate %qrFl%ent %
5( eading
lNone % mn#asi$ %opIntermediate %qrFl%ent %
6( 7riting
lNone % mn#asi$ %opIntermediate %qrFl%ent %
,-Categories of international st!ents"
st/ e8$hange st%dent % ]u/Lang%age st%dent %
vw/short time training st%dent % Wx/9%nior $ollege st%dent % yx/0ndergrad%ate %
z{B|}'his appli$ation "orm has to +e mailed to`
<`~7625 @ XM!+ BCDA`210048
&dd ` International Education Institute, Nanjing College of Chemical Technology, No.625
Geguan Road, uhe !istrict, Nanjing "iangsu, China, 2#$$%&
'el* :;<-4=-=;5>?;;<:;<-4=-=;5=1??< ,-mail* 1sn1hyg1y@gmail($om
MQWXDesired ma$or%
MQ1Period o" st%dy*
2Aear 3Month to 2
Aear 3Month
>?/GH
'el(/Cell No(
lfg]u
Pro"i$ien$y in Bther Foreign
Lang%ages
}Z[
!ate o" &rrival
(yyyy/mm/dd)*
&mergenc# "ontact 'famil#(
relati)es( friends( etc.*
"ontact + 'in home countr#*
Name* elationship*
&ddress* Mo+ile phone*
"ontact , 'in "hina*
Name* elationship*
&ddress* Mo+ile phone*
`
!MQ1[-!MU!lyMQ
I here+y a""irm that*
1( &ll the in"ormation in this "orm is tr%e and $orre$tC
4( I shall a+ide +y the laws o" China and the reg%lations o" the S$hool) and will not parti$ipate in any a$tivities )whi$h are deemed to +e adverse
to the so$ial order in China and are inappropriate to the $apa$ity as a st%dent(
01` 2 3 0 `
!ate* Y M D &ppli$antDs Signat%re
`yZs emar3s* 'he appli$ant is reE%ired to s%+mit*
1(OJ 1( photo$opy o" passport
4(KLMNJ 4( photo$opy o" highest ed%$ation $erti"i$ate
5( 5( #ody $he$3 $erti"i$ate
6(MQRNJ 6( photo$opy o" a$ademi$ and wor3 e8perien$e $erti"i$ate
./0
-iews of !nternational &ducation
!nstitute
12/Signat%re* FFFFFFFFFFFFF 34/!ate FFFFFFF5/Aear FFFFFF6/Month FFFFF3/!ay
789/0
-iews of the principal
of the college
12/Signat%re* FFFFFFFFFFFFF 34/!ate FFFFFFF5/Aear FFFFFF6/Month FFFFF3/!ay
z{B|}'his appli$ation "orm has to +e mailed to`
<`~7625 @ XM!+ BCDA`210048
&dd ` International Education Institute, Nanjing College of Chemical Technology, No.625
Geguan Road, uhe !istrict, Nanjing "iangsu, China, 2#$$%&
'el* :;<-4=-=;5>?;;<:;<-4=-=;5=1??< ,-mail* 1sn1hyg1y@gmail($om