APPLICATION FORM FOR MBBS IN CHINA(2011-12) Admission Off: Han Kou Lu Qingdao Shi, Shi Bei District China 266071 T E L : +86-18678985218 / +86-13668880839 F A X : +86-532-83621019 EMAIL : info@chinambbs.org Website: www.chinambbs.org APPLICANTS PHOTOGRAPH University/College Applied For: TO BE FILLED IN BLOCK LETTERS 1. Full Name: 2. Sex : Date of Birth : Nationality: 3. Father s Name Occupation 4. Mother s Name Occupation 5. Present Address Pin code : STD Code Tel: 6. Permanent Address Pin code : STD Code Tel: 7. Email: Fax: 8. Educational Qualification:
a) Name of School/College/University Last attended: b) Certificate/Diploma/Degree obtained: c) Year of Completion: 9. Course Of Study applied for: 10. a) Applicants Passport No. b) Place of Issue b) Date of Issue c) Date of expiry If the student / applicant hold no passport please mention: List of necessary documents to be attached: a) Higher Secondary School Certificate / Any other document certifying the date of Birth b) Qualifying Examination Transcript ( 10+2) c) Transfer Certificate d) C.R.R.I. Certificate, Degree/Diploma Certificate, Statement of Marks, & Medical Council Regn. Certificate (in case of Post Graduate course applicants) e) Medical Fitness Certificate from any registered Medical Practitioner f) HIV-AIDS Test Result (with seal) g) 8 Passport Size Photographs Notary Verified Photocopies FOR OFFICE USE Submitted on: By Person / Post File No:
REMARKS: Application Form for Foreign Students Intending to Study in China at Their Own Expenses Nationality Name Sex Male Female Place of Birth: Date of Birth Marital Status õ Yes õ No Passport No. School of graduation Last Degree Work Unit Health Conditions Language Profession Applying Bachelor s Degree Five Years Seven Years Status Postgraduate Master s Degree Doctor s Degree Scholar General Scholar Senior Scholar Period of Study Date Month Year Date Month Year Address Telephone: FAX: E-mail: Resume Month Year Month Year Study or Work Experiences Status
Note: If the blank of resume is not enough, add another piece of paper to write. Fill out the following requirements: 1. Any foreign citizens, who admit the Constitution and Laws of P.R. China and intend to apply to our university/medical college for study at one s own expense, can fill in this form. 2. Please print or write clearly and truthfully. 3. If we find that the content of the application form is not truthfully filled in, we reserve the right to reject the applicant s admission. RULES AND REGULATIONS 1. The Students should read the information hand out thoroughly, before filling up the Application form. 2. (I) The minimum eligibility criteria to get admitted into Under graduate Medical Course is that: a student must have passed in the subjects of Physics, Chemistry and Biology & English individually and must have obtained a minimum of 50% marks taken together in Physics, Chemistry and Biology. The student should satisfy himself/herself that he / she is eligible for the course when he / she opt to study in our institution. (II) For Postgraduate courses the students should have obtained a Bachelor s degree from a recognized University. (III) The admission authorities of the applied university/ college reserves the right of selection on an individual based upon the students previous academic performance. 3. The Students shall submit notary attested photocopies of the documents called for along with the application form. After screening if selected the students shall be informed and the student shall submit the documents called for in original. 4. If any information provided in the Application form by a student is found to be false or incorrect, such application will be rejected and suitable action is liable to be taken by applied university/ college and/or its representatives against such students. 5. Applied university/ college and their representatives are not responsible for any false information given by the students at the time of admission and also for the consequent problems. Applied university/ college and their representatives are
reserves the right to Proceed against them legally and cancel their admission with no consequent duties and responsibilities. 6. The selected students shall be admitted to the course only on the condition that they will be governed by the rules and regulations of the College / University. 7. The eligible students shall execute an agreement on selection for admission and the pay the seat confirmation / tuition fee. 8. A fee once paid is non- refundable under circumstances. 9. The information provided to the students by applied university/ college and their representatives are in Information Brochure is subject to change without prior notice. Applied university/ college and their representatives are is not responsible for any changes with regard to eligibility or any other amendment made by the institution or the respective Governments at the given time. 10. The annual tuition fees for the courses of study are to be paid by the students directly to the Institution of study on or before the due dates intimated to them from time to time. 11. If there is any delay in remittance of college / Academic / Hostel Fees the student can be suspended from college or even held back from appearing for their University conducted Examinations. 12. Any student found guilty of involving him / her in any activity which can be termed as illegal or unconstitutional or against the interests of the Institution/Country can be dismissed from the college with a due intimation given to his/ her Parent / Guardian. Readmission of such candidates shall be subject to the decision of the disciplinary committee of the University. 13. Mere submission of application form does not guarantee admission to institution unless the student is found fit by the admission committee. 14. For all other matters not specifically mentioned here in, the decision of the applied university/ college and their representatives are is final and shall be binding on the student and the parent. 15. All disputes are subject to jurisdictions of Courts in the city of applied university/ college, P.R.China only.
DECLARATION I the student & I the Parent of the Applicant Residing at Do hereby declare that we have read the above rules and regulations of applied university/ college and their representatives and we shall abide by the same. Signature of the Student Signature of Parent / Guardian Date: Place: