PDF《香港中文大学 雅礼中国语文研习所》

1 CUHKC CL LC C 暑期语文活动/ 实习课程报名表格 (校内生版) Enrolment Form for Summer Language Activities/ Internship Programmes (CUHK/ CLC student version) 请於填写报名表格前细阅「申请须知」及课程简介并以正楷填写此表格,报名连同 签署好的表格及「申请须知」一并交回本所.Please fill in this form in BLOCK LETTERS and read the Notes to Application and curriculum carefully before filling in the form. Application by sending in signed application form and Notes to Application . 甲部 Part A: 课程详情 Course details ?请勾选 check the box *请删除不适用者 please delete if appropriate #必须填写 Mandatory 活动/ 课程名称 Activity/ Course title 活动/ 课程时间及地点 time and place 第一选择 1st choice 第二选择 2nd choice 乙部 Part B : 个人资料 Personal Particulars 英文姓名 中文姓名 称谓: ?先生 ?小姐 ?太太 ?女士 Name in English:Name in Chinese Title: Mr. Miss Mrs. Ms. 姓氏 Surname 名字 First Name (必须与香港身份证或护照相同 Must be the same as shown on HK ID card or passport) 香港身份证/ 护照号码: 签发国家 (如有): HKID Card/ Passport No:Issuing Country (if any) (用作核实申请人身份 For verification of the applicant'

s identity) (项目在中国进行请填写 Please fill in if the item takes place in China) 中国签证/ 回乡证编号 China visa/ huixiangzheng no: 国籍 性别 出生日期: (日/月/年) Nationality_Sex_Date of Birth: (dd/mm/yy)__ 手电: 住宅

电话: 联络传真: 电子邮箱地址 Mobile:Home Telephone:Contact Fax:Email Address: 通讯地址: Correspondence Address: 紧急联络人 姓名 电话 关系 Emergency contact: Name Telephone:Relationship: 学生类别 (请勾选最近期的一项) Student type (please check the latest one) ? 研习所全日制课程 CLC full-time (Regular) programme. ? 中大交换生或国际本科生课程 CUHK exchange/ International undergraduate programme. 原校 Home School/ 主修 Major: ? 研习所兼读课程 CLC Part-time programme ? 中大本地本科生 CUHK local student. 主修 Major: 与上述选择有关的最近期的课程编号 The Course code of the latest course related to your selection above: 丙部 Part C : 其他要求(若适用) Other Request (If applicable) ? 单人房 (须缴交附加费) Single room (additional charge required) ? 目的地集合(学生自行安排交通并於指定时间与大会合,收费可获酌量减免,详情见课程/活动单张.须提供详细交通安排) Landing option (Students are to arrange air and/or ground transportation on their own and to meet the big group at designated time and place. Fees will be modestly reduced. Please refer to the programme /activity brochure for details. Detailed transportation information should be provided to the Centre.) ? 目的地延期逗留(需自理签证、交通及住宿) Extended stay in the destination (Accommodations, visa and transportation to be taken care by students) 回港预定日期 Expected returning date to Hong Kong: YALE-CHINA CHINESE LANGUAGE CENTRE THE CHINESE UNIVERSITY OF HONG KONG 地址 Address: 香港新界沙田香港中文大学 Shatin, N.T., Hong Kong, SAR 网页 Homepage: www.cuhk.edu.hk/clc 电邮 E-mail: [email protected] 电话号码 Phone : (852)2609

6727 传真号码 Fax : (852)

2603 5004 由本所填写 Office use only ? 录取 ? 不录取 ? 后补名单 Admitted Rejected Waiting List ?HK$报名费已收 Application Fee Received ? 以支票/本票支付 Paid by cheque / bankdraft ? 以信用咭支付 Paid by credit card ?HK$学费已收 Tuition Fee Received ? 以支票/本票支付 Paid by cheque / bankdraft ? 以信用咭支付 Paid by credit card 香港中文大学雅礼中国语文研习所