西安交通大学第三届丝绸之路医学国际青年学者论坛申请表

1、西安交通大学第三届丝绸之路医学国际青年学者论坛 申请表Aplication For The 3rd Silk Road International Symposium for DistinguishedYou ng Scholars (SRIS, XJTU Health Scie nee Ce nter, 2017)(非公开信息)(No n-Public)、个人基本信息Basic In formatio n姓名Name性别Gen der出生年月Date of Birth专业领域及 方向Area of Expertise and ResearchIn terest出生地Place of Birt

2、h现工作单位Curre nt Employer专业技术职务Professi onal Positi on最后学位及 授学位单位Highest Degree Awarded and School of Graduati on国籍Natio nality有效身份证件名称及号码Name and Number of Valid Ide ntificati on通讯地址Address邮政编码Postcode联系电话Teleph one Number固定电话Fixed手机号码Mobile电子信箱Email二、教育经历（从大学填起，按时间顺序正序填写）Educati onal Experie nee (Pl

3、ease prese nt in chrono logical order, start ing from the bachelor degree)起止年月Start-Due Date院校Un iversity专业Major学位Degree三、工作经历（请按时间顺序正序填写，兼职请注明）Work Experie nee (Please prese nt in chrono logical order and in dicatethe part-time positi ons)起止年月Start-Due Date工作单位Employer职务/职称Positi on四、业绩综述（1000字以内）S

4、ummary of Academic Performanee (Within 1000 words)五、代表性成果Represe ntative Achieveme nt1、代表性论文 (10 篇以内)Represe ntative Publicatio ns (Within 10)作者（按顺序写出全部作者，通讯作者标注*号）；论文名称；发表刊物名称；期号、起止 页码；出版或发表年度Authors （Please prese nt all authors and mark the corresp onding author with* ）;Title;Jour nal Name;lssue a

5、nd Page No.; Year of Publishme nt论文影响力（期刊影响因子，被引用情况，被价情况等）Publication Impact （Journal IF, citation, evaluati on and etc.）2、代表性著作(3 部以内)Representative Works (Within 3)著作名称Book Title出版单位Publisher作者Author出版年度Publicati on Year3、专利(已授权，10项以内)Patents(Granted patents, within 10)专利号Pate nt No.专利名称Pate nt Na

6、me类别Type授权国家Country of Granting专利所有者Owner4、获奖（5项以内）Awards（Within 5）获奖或荣誉 名称Name of Award orHonor颁发机构Issued by获奖等级AwardLevel获奖年份Year排名Ranking主要合作者Main Partner5、主持（参与）的科研项目（10项以内）Projects(leading or participating) (Within 10)起止时间Start-Due Date项目名称Name经费来源及额度Source and Total Amount of Funding申报人的具体职位 和任务Positi on andResp on sibilities of theApplica nt6、学术组织任职、重要学术报告（10项以内