中国100青年英才培养计划报名表

1、中国100青年英才培养计划报名表姓 名性 别民族相片出生年月身份证号家庭电话手 机E-mail通讯地址邮编就读学校专业（文科理科）就读年级担任职务现任曾任校内外社会工作及获奖情况由至（年月）活动名称活动规模（国际国内跨校校内）担任职务日期曾荣获的奖项曾获与学业成绩相关的校内、外奖学金（按顺时序列出）日期奖学金名称颁发机构志愿者服务或社会服务经验日期服务内容服务时数服务机构组织参与语言能力（请在相应水平打）英语精通良好一般其他（ ）精通良好一般请撰写一篇名为我对英才的理解及自身与英才目标的比较的短文，字数不超过500字（可另附）申请人认为需要补充的资料：声明书在签署本表格同时，本人确认：1. 本

2、表格及随附文件所提供的资料均正确无误，并无缺漏；2. 若成功获选，将承诺全力参与中国100培训计划的学习、考察活动，达到课程要求；3. 若成功获选，将承诺愿意竭尽所能，服务社会；4. 若成功获选，同意自动成为中国100青年英才俱乐部会员，并同意将以上个人资料用作中国100青年英才俱乐部的联络及通讯。申请人签名：年 月 日就读学校负责人推荐（报名表须交学校填写及盖章）名 称负责人姓名负责人职务职 称联系方式联络地址邮 编负责人对申请人的评价：在签署本表格时，本人确认：1. 以上申请人所填写的校内成绩及校内社会工作资料均正确无误；2. 同意中国100青年英才培养计划办公室向本人及本校收集本人及受推

3、荐人的资料，以作审核此次报名之用。负责人签名： 盖 章：年 月 日 年 月 日家长意见我同意并支持 参加中国100青年英才培养计划所有学习和社会活动。 家长签名： 年 月 日报名表格 Application Form中国100青年英才培养计划China 100Youth Elite Project Application FormNameGenderNationPhotoDate of BirthID. Card No.Home Tel. No. MobileE-mailCorrespondence AddressZip CodeCurrent SchoolMajor（Arts / Scien

4、ce）GradePost(s)Current / Previous Social Work and Prize(s) Innside and Outside SchoolFrom / To(yy / mm)Name of ActivityScale of activity (International / National / Inter-school / Inside school)Post(s)Date(s)Previous Prize(s)Previous Academic-related Scholarship(s) / Prize(s) (In chronological order

5、)Date(s)Scholarship(s)Issuing Body(ies)Voluntary Work or Community Service ExperienceDate(s)Content of Service(s)hour(s) of Service(s)Name of Organisation(s)Organize or participate,Language Proficiency（mark up “” at The corresponding place）EnglishExcellenceGoodFairothers（ ）ExcellenceGoodFairPlease w

6、rite an essay of no more than 500 words in Chinese entitled “My understanding of Youth Elite, and my Advantage and shortcoming comparison with the objectives of Youth Elite”.Additional Information of Applicant:DeclarationUpon completing and signing this Application Form, I confirm that I:5. certify

7、that all the information provided above and all the enclosed supporting documents are complete and accurate to the best of my knowledge;6. shall make every effort to the china 100Project and Reach the Courses Requirements, if successful;7. shall make every effort to the serve the community with devo

8、tion, if successful;8. hereby give my consent to become a member of “China 100” Youth Elite Project and to release my personal information given above for,if successfui;Signature of Applicant:Date:Recommendation from Principal of Respective School(Applicants should submit the form to school for comp

9、letion and certification) Name of SchoolName of PrincipalPost(s) of PrincipalTitleTel. No.Correspondence AddressZip CodeComments on Applicant from Principal:Upon completing and signing this Application Form, I confirm that I:1.certify that all the information the applicant provided related to academ

10、ic rank and leadership post(s) at school are accurate to the best of my knowledge;2.hereby give my consent to the Secretariat of “China 100” Youth Elite Project to carry out necessary reference check and investigation with myself or my school for the purpose of assessing this application.Signature of Principal: Stamp