课
程
程
资
讯
讯
综
合
合
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PART I – 申请人信息 APPLICANT INFORMATION | ||||||
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姓名 |
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性别 |
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出生日期 Date of Birth ( Month / Day / Year ) |
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Name |
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Gender |
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学号 Student ID |
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PART II – 护理教育NURSING EDUCATION | ||||||
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护理院校名称 |
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Name of Nursing School Attended |
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院校地址 |
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Address of Nursing School |
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专业 |
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Specialty |
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学历 |
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Name of Diploma |
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学位 |
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Degree awarded |
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毕业时间 |
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Date of Graduation |
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学校是否为教育部门认可院校？ Is the Nursing School Government approved? |
Yes No | |||||
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申请者签字及时间（请用中文签名） Applicant’s Signature and Signature Time( Month / Day / Year ) |
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PART III – 成绩记录 ACADEMIC RECORD （由出具证明的学校填写，要求真实准确） | |||||||||
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专业 |
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学号 |
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学制 |
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科 目 |
Courses |
Teaching hours |
Score |
科 目 |
Courses |
Teaching hours |
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PART IV – 学校信息AUTHORIZED AGENT INFORMATION | ||
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出具证明学校名称 |
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Official Title of Authorized Agent |
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电话 Telephone Number |
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传真 Fax Number |
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电子邮件 Email Address |
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出具证明时间 Verification Time |
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经办人签字Transactor’s Signature |
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学校盖章 Signature of Authorized Agent
注：除此处盖章外，请在PART III成绩记录一页右下角盖章 |
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