Committee of 100 Leadership Scholarship Application Form.doc

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1、Committeeof100LeadershipScholarshipApplicationForm(Year2016-2017)百人会英才奖申请表（2016-2017学年）仅限研究生ForGraduateStudentsOnly所有资料请用中文或英文填写。AllinformationshouldbecompletedinChineseorEnglish.如资料填写不完整，申请可能被视为无效。Allsectionsofthisformshouldbecompleted,otherwiseapplicantmaybedisqualified.一、申请人基本情况/Persona

2、lInformation姓名FullName姓名汉语拼音NameinPinyin生日BirthDate年月日YMD性別Sex民族Ethnicethnicethnicethnic婚否MaritalStatus家庭人均年收入AnnualHouseholdIncomePerCapita收入来源IncomeSource电邮Email手机Mobile电话Tel当前通信地址PresentAddress永久通信地址PermanentAddress二、学业信息/AcademicInformation现就读Current大学University学院School系Department专业Maj

3、or攻读学位DegreeExpected就读时间Duration自至FromTo曾就读Previous大学University学院School系Department专业Major所获学位DegreeEarned就读时间Duration自至FromTo曾就读Previous大学University学院School系Department专业Major所获学位DegreeEarned就读时间Duration自至FromTo三、申请英才奖的相关材料/SupportingInformation1、在读期间成绩/AcademicPerformanceofGraduateStudy(1)

4、在读期间成绩单（请另附）TheMostRecentTranscript.(Pleaseattachittotheapplication)(2)最近一学年课程平均成绩及年级排名班级人数：AveragedScoreandRankingintheClassforMostRecentYear2、曾获奖项（列出不超过7个）。请简要说明每个奖项的评选方式和重要性。/Honorsandawards(Listonlyseven)Pleasedescribethemethodologyofselectionandsignificanceofeachhonorandaward.3、列出申请人在

5、社会公益、创新创业、或中美交流三个领域中最引以为豪的三段经历。可选择其中一个或多个领域。简要介绍每段经历并说明申请人引以为豪的原因。每段经历的陈述不宜超过100字。PleaselistthreeactivitiesyouaremostproudofinthefieldsofSocialService,Innovation&Entrepreneurship,or/andUS-Chinaexchange.Describehowtheseactivitiesmadethesocialimpactandwhyyouareproudofthem.Wordlimit100wordsin

6、Chinese;75wordlimitinEnglish.四、推荐人声明StatementfromRecommender(CannotbethesamepersonastheNominator)请推荐人说明推荐理由。推荐人应说明与申请人为何种关系、结识时间和原因；举例说明该申请人在创新创业、社会公益或中美交流领域展现出来的领导才能；并与相同领域中其他同类人员相比较，说明该申请人如何可以脱颖而出。推荐人需签名或加盖公章，并提供其职务、电子邮件和手机信息。不超过800字。Pleasedescribewhyyouarerecommendingthisstudentforthisa

7、ward.Therecommendershouldexplaintherelationshipwiththisstudentandwhenandhowyouknewthisstudent.Pleasegiveexamplestoexplaintheapplicant’sleadershipandperformanceinthefieldsofInnovation&Entrepreneurship,Volunteer&CommunityService,or/andU-Chinaexchange.Howdoesthea