School of International Education, Heilongjiang University of Traditional Chinese Medicine

Application form for short-term Study in Heilongjiang University of Traditional Chinese Medicine

HeiLongjiang University of Chinese Medicine Application Form for Short-term Study and Training

name Name	surname Family Name	name Given Name
nationality Nationality	passport number Passport No	gender Gender	marital status Marital Status
date of birth Date of Birth（D/M/Y）		incunabulum Place of Birth
official academic credentials Highest Academic Degree Attained		religion Religion		profession Occupation
Correspondence address of the place of nationality Mailing Address in Original Country
Telephone or fax number of your country of nationality Telephone or fax number in Original Country			address E-mail
To apply for course Program for Application		learning time Time of Study or Training
TCM Traditional Chinese Medicine (TCM) acupuncture and tuina Acupuncture, Moxibustion and Tuina other other		Learning begins and ends year month day， by a definite datesky My study will begin fromD M Y， and will last fordays
learning style Style of Study	theory course clinical practice Theory course + clinical practice
study experience Education Experience
time Time	school name Name of School		specialty Major	degree Degree





I hereby promise that I will abide by the laws of China and the rules and regulations of the university during my study in China。 I hereby guarantee that I shall abide by the laws of the Chinese government and the regulations of Heilongjiang University of Chinese Medicine

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