LSE-PKU_form by cuiliqing


									     Please read all the information in the shaded area carefully
     before completing this form. Please use black ink and BLOCK
     CAPITAL letters when completing this form. Please avoid using                                  PEKING UNIVERSITY
     non-standard characters such as umlaut (ä), tilde (ñ) and                            中国100871 北京市海淀区颐和园路5号
     circumflex (ê) as these cannot be recorded on our database.
     Please complete the form in English. Further information is             School of International Studies
     available on our website                                      
                                                                             Peking University, Beijing 100871, China
     taughtprogramme/doubleMScDegree in                                                                                                                             片
     InternationalAffairs.htm                                                                                                                                     Photo
     All from the Peoples Republic of China, Taiwan, Hong Kong,
     Macau and Taiwan who do not have dual nationality must first
     also complete National Entrance Examination for Postgraduate
     students in China listing PKU as one of their choices and then
     apply directly to PKU using the Word application form available
     here.                                                                   London School of Economics and Political Science
                                                                             Applicants from Peoples Republic of China, Taiwan,
     AFTER COMPLETING QUESTIONS 1-23 AND                                     Hong Kong, Macau and Taiwan who do not have dual
     THE MONITORING FORM, PLEASE FOLLOW                                      nationality ONLY. All other applicants should apply
     THE INSTRUCTIONS AT THE FOOT OF PAGE 3.                                 online via LSE.

     Personal information 申请人情况                                              LSE/Peking Double Degree in International Affairs
                                                                                                                                      Previous surname (if applicable)
1    Surname (family name) 姓              (BLOCK CAPITALS)
     This is the name under which your file will be registered and the
     name you should use on any future correspondence with us

2    Title                                                                   Ms           Mrs              Miss        Mr        Dr          Professor       Other (Please specify)
     Please tick the title you normally use eg Mr, Ms etc

3    Forename(s) 名 (given names) in full (BLOCK
     Please write all your forename(s) in the order in which they
     normally appear. Initials are insufficient

4    Known as
     Please write the forename you prefer to use eg Robyn

                                                                                                                                      Male                       Female
5    Date of birth 出生日期                                                                                            6      Sex
     Note the format: DD/MM/YY                                               Day       Month       Year                   性别
     Programme details
7    Are you or have you ever been a student,                                Staff? YES/NO                        LSE student? YES/NO              Previous applicant? YES/NO
     member of staff or previous applicant
     (including undergraduate) at LSE?
     Providing this information helps us to minimise delays in
     processing your application. Please enter your LSE
     student/staff/applicant number, if known

     Communication with you
8    Email (one address only) 电子邮件

9    Permanent home address 家庭住址
     Your permanent home address. this address will be used for all
     correspondence unless you give an alternative address below.

                                                                             Postcode/zip code邮政编码                                    Country国家
                                                                             Telephone/Mobile 电话
                                                                             Fax 传真
10   Correspondence address                                                  From                                                     To
     Please leave this section blank if the address is the same as the       Day                   Month           Year               Day                Month            Year
     address provided above.

                                                                             Postcode/zip code 邮政编码                                   Country 国家
                                                                             Telephone/Mobile 电话
                                                                             Fax 传真

     Nationality and residence details
11   Nationality国籍

12   Place of birth 出生地                                                      Country 国家                                     13        City 城市

14   Country of residence 居住国家
     The country in which you have been normally resident, except for
     periods of temporary absence, since 1 September 2004.

FOR OFFICE USE ONLY                ID number                     2       0         0           6                                                     Fee Status          Ad Fee
     Entry qualifications                                                Please give your academic history to date. Please do not attach a curriculum vitae/resume

15   Qualifications held/pending 受高等教育情况
     Name of                  Dates attended (eg 2000-2003)              Title of degree awarded and class of degree eg Economics     Principal/major subject taken eg
     University/College       在校时间                                       BA (Hons) 2:1; JD with GPA3.7 or in the standard format      Economics, Accounting. Date
     and Country 学校                                                      for your degree 在大学情况                                        awarded (DD/MM/YY)

     Current modules/courses eg International Economics                                                                               Module/course value eg half unit,
                                                                                                                                      whole unit

16   Is English your first language? 英语
     See for further
     information. Keyword: English
     Is/was English the language of instruction                          YES/NO
                                                                                            If you have replied ‘yes’, please attach documentary evidence
     for your degree?
     I took/will be taking the English language test                     Day                              Month                                  Year
     Your test must have been taken in the last two years
     Type of test taken:                                                 IELTS                                                  TOEFL

     Test score:                                                         Listening         Structure/Writing                    Reading                      Speaking (if

     Total score/overall band:

17   Language skills其它语言
     Please state what languages other than English you know and
     your level of fluency in speaking (S) and reading/writing (W)
     them. Use grade 1-3 where 1=basic ability, 2=advanced ability
     and 3=fluent/first language eg French S1

18   Native Language 母语

19   Academic interests and purpose of study
     All applicants – please attach a personal statement that
     your special academic interests and your purpose and objectives
     undertaking graduate study. If you are applying for a master’s or
     diploma programme this is your opportunity to introduce yourself
     the selectors. Please describe your academic background,
     strengths/interests, ambitions/research interests. Your statement
     should be typed, and should cover 2-3 sides of A4 paper.
     Other information
                                                                      Please give your employment history or other professional experience to date, if relevant, including
20   Employment history 工作经历                                          any internships

     Dates from and to       Nature of work and position held 从事工作职务                                                   Name and address of employer 工作单位

21   Name of First Academic Referee/                                                                                           Email (if known):
     Please provide your referee’s name and email address if known.
     If not known leave blank
22   Name of Second Academic Referee/                                                                                          Email (if known):
     Please provide your referee’s name and email address if known.
     If not known leave blank

     Please send with this form
     (1)        An official certificate of your highest education (or notarised photocopy)
     (2)        An official transcript (or notarised photocopy) 学习成绩单
     (3)        A statement of your research plan 研究计划
     (4)        Two letters of reference/recommendation (original) 推荐信
     (5)        The application fee 申请费
     (6)        One photocopy of your passport 护照复印件
     Please Note: Where applicable, the above documents must be accompanied
     with a certified English translation.
     Whether the candidate is accepted or not, all the application material will not be returned.
     I declare that the statements on this form are correct. I understand that any offer of admission may be withdrawn if I cannot provide
     documentary evidence of any statements on this form. I agree that LSE/PKU may process the information contained in this form and
     retain it for five years for statistical and administrative reasons. 申请人保证上述各项中所提供的情况是真实无误的

23   Signature申请                                                                                 Date日
     人签字                     _____________________________________________________               期              _______________________________________________

     After completing this application form, please follow the instructions below:
     Please send the original application and all        Please email a copy of this application form as an
     supporting documentation by post to Peking          attachment to:
     Room B114
     School of International Studies
     Peking University
     Beijing 100871
                                                                  Monitoring form
                                                                  This section of the application form will be separated from
                                                                  the main form before the application is sent to the selector
Disability, special needs
or medical condition codes
LSE aims to create an environment which                           Disability, special needs or medical condition
enables all students to participate fully in
university life.                                                       00 None                                         05 You require personal care support
To help us make any reasonable adjustments
which may be necessary, please use the                                 01 You have a specific learning difficulty      06 You have mental health difficulties
                                                                        (for example, dyslexia)
following codes to indicate your specific
needs.                                                                                                                  07 You have a disability that cannot be
You may arrange to visit the School and meet                           02 You are blind or partially sighted            seen, for example, diabetes, epilepsy
                                                                                                                         or a heart condition
the Adviser to Students with Disabilities, or
make contact by email at an early stage, to                            03 You are deaf or hard of hearing
discuss this further: Disability-
                                                                                                                        08 You have two or more disabilities                                                     04 You use a wheelchair or have
                                                                        mobility difficulties                           09 You have a disability, special need or
                                                                                                                         medical condition that is not listed above

                                                                                                                        10 You have Autistic Spectrum Disorder
                                                                                                                         or Asperger Syndrome

UK students only
Please let us know if you are in receipt of a Disabled Student
Allowance, or are likely to apply for one.
Please tick the appropriate box:
                                                                       DSA in place                                    DSA applied for

Ethnic Origin
We use this information to monitor                                Ethnic origin codes
applications and equal opportunities. You may
leave this section blank if you would prefer                            White British or White                            Asian British or Asian
Please tick the appropriate box:
                                                                       11 British                                       31 Indian
The ethnicity categories used here are those established by the
UK government and used by the UK Higher Education Statistical          12 Irish                                         32 Pakistani
Agency (HESA)
                                                                       14 Irish Traveller                               33 Bangladeshi

                                                                       19 Other White background                        34 Chinese
                                                                        If other please specify:
                                                                                                                         39 Other Asian background
                                                                                                                         If other please specify:
                                                                        Black British or Black                           ________________________________
                                                                       21 Caribbean                                     Mixed
                                                                       22 African                                       41 White and Black Caribbean

                                                                       29 Other Black background                        42 White and Black African
                                                                        If other please specify:
                                                                                                                         43 White and Asian

                                                                        ________________________________                 49 Other mixed background

                                                                                                                         80 Other ethnic background
                                                                                                                          If other please specify:



Passport Number 护照号码                                                                                                 Valid Until 有效期至

Passport Name 护照用名

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