Given name

Nationality

Passport No.

Date of birth

year /month /date

□Male

□Female

□Married

□Single

Place of birth

Religion

Highest education level

Occupation

Employer or school affiliated

native language

Permanent mailing address:

Tel: /Fax: E-mail:

Study duration

from Y /M /D to /Y /M /D

Check the appropriate box to indicate the number of Chinese words you know.

A None B about 200 C about 600 D about 1000 E over 2000

Program applied for:

1.major:

2. /Degree courses

① Bachelor –CM（5years□）、BMEIS/MBBS (6 years □)

② Master(3years) □

International students, who will study their major in Chinese language,

need to pass HSK certificate level 3—6.

Sponsor’s mailing address /Tel

Sponsor’s signature

Family members

Name / Relation / Tel. & Fax

Curriculum vitae（Starting from high school）

previous and current education & employer /years attended (from/to) /Position

I am willing to study at NSMC. I pledge the following terms during my study:

1. I will abide by the laws of the People’s Republic of China.

2. I will study industriously and observe all rules and regulations of the University.

3. I will pay all expenses on time.

4. All the information in this form is true and correct.

Applicants signature

Date