国籍

Citizenship

出生年月

Date of Birth

年     月    日

yy      mm     dd

护照号码

Passport No.

性别

Sex

男Male□ 女Female□

邮箱

E-mail

手机号码

Cell Phone No.

学号

Student  number

学生类别

Student  type

语言生Language student □

本科生Undergraduate  □  

研究生Postgraduate □

学习时间（年）

length of  schooling(Year)

1 □     2 □    3 □

4 □     5 □

奖学金类型

Scholarship  

type

政府奖学金Goverment scholarship □

孔子奖学金Confucius scholarship □

学校奖学金 University  scholarship□

自费self-paying □

入住时间

Room  needed

自           年       月       日  至             年       月       日

From         yy       mm       dd  To         yy        mm      dd 

房型选择

Room  type choosing

单人间Single room□       双人间Double room□      三人间Triple room□

（奖学金生统一分配三人间，选择其他房型需补交差价           元）

The students at public  expense are distributed in the triple.

They will be required  to pay the fees          RMB if  choosed single or double room.

特殊需求

Room  preference

(We will try to meet your preference  but not guaranteed)

楼层\朝向\室友\是否抽烟（Floor\Facing\Roommate\Smoking:  Yes or No）

个人承诺

Personal  commitment

本人承诺达到以下申请要求：

①      遵守中国各项法律法规

②      上课及出勤表现良好

③      严格遵守公寓规章制度且服从管理

否则，将自愿放弃留学生优惠政策，不再享受公寓优惠房价。

I, hereby commit to meet  the following requirements for application :

①      Abiding by the  laws and regulations of People's Republic of China

②      Well  performance and attendance on classes

③ Strictly  following the regulations  of dormitory management.

In case of any breaking  of any rules and regulations stipulated in the above items, the referential policy  for foreign students and their dormitories referential charge price will be deemed  as automatically waived.

签字确认

Signature

姓名Name：                                   时间Time：        年(yy)    月(mm)    日(dd)