PHONE tn thW 18 ~2015 0458PIIcirc Pl bullbullbull _I wtQQlf~RtQBmt4lQ v~bullbull_~u-

4~ ~~~jl) ~jJl~~ 4J~Jl Reacutepublique Algeacuterienne Deacutemocratique Populaire

Ministegravere

Direction de la Coopeacuteration ot des j nterulliveuror~jta ires

Ndeg ~SA 2~fDCEIUJ 20Hi i B

Messieurs Jes Preacutesidents

des Confeacuterences Reacutegionales Univers

Est-Ouest-Centre

le

coparraineacutees UNESCOReacutepublique PopulairE 1ltgtltgt et Formulaire

J~l lhonneur vous informer le Ministegravere de [Enseignement

Recherche dune

deacutetudes au de universitaire 201 7

de lUNESCO relative au programme de bourses coparraineacutees

UNESCOReacutepublique Populaire Chine

programme bourse est destineacute aux eacutetudiants poursuivre

des supeacuterieures en Chine au seacutelectionneacutees

Vous trouverez ci-joint une dinformation du programme ainsi qUE~

le candidature pour formation

Je vous dispositions que vous voudrez bien prendre

offre et vous prie nous parvenirpour une

avant le en vue de faIcircre

parvEmir dans les temps req aux instances concerneacutees

ConsideacuteratiQn distingueacutee ~ 1- bullbull ~~

-

gt

FRCltl

()OcirclHHX ~lt)fr()GltlI )(lpl30aHll

1 K)I1lgtljP

~I~I r-gtIl~ (-Wj 41Jl

+31 ccedil~ middotmiddot3~

rlAY 18 2016

The Assistant DIcircrector-Go 11i (middot3 1 for Pu)lic

J-~~) - ~J jLJtll J

~~ll 1

States invited

Rel 6LNivl81

UNE5COPeople$ Repllblic of China Great Wall) F~liowships Programma Z01 17

ANNOUNCEMENT

Cl f the

Offered in open ar) intended for advanced Btudiss at and for on8 year at Crfi1euro)se

should be submIcirctted as thif the mosi ngtll1li

priority to gelldecircr

A certain number of are Int~ndeci of preshyteacuteltlchers teact~er educators and tralners from the ten (10) CFIT countrIcirces to pursu(t an Taa~her at tlle Normal UniverSity

~L~~~~~~~~~~1~and~1gt1~~~~~i~~~l~

Vours

The annexes ta quallficaticwls the feacuteHowships as weil ~S the

We Wouid Mf Cllief

7 Place de Fontonoy ~ the latest An advance CQPy must be sent

cc RBPublic of CtlIcircnegrave 0 UNESCO

form

cOlwicirc(i(3S)

tlAy 18 21316 051~2Pt1 P2PHDtJE NOFROfl

2 ni e

ANNEX 1

OF CHIW~ THE WALl co- FELLOWSHIP~ PROGRAMME

2016 - June 2011

Member ilivited tocirc submlt

AFRICA 4$IVIember State~

ANGOLA lE80THO BENIN LIBERIA BOTSWANA MADAGASCAR BURKINA FASO MALAWI 8URUNDI MAL CAMEumlFlOON MAURITIUS CABOVERDE MOZAMBIQUE CENTRAL AFI~CAN f~EFUBUC NAMIGIA CHAD NIGER COMOROS NIGERIA CONGO RWANDA COTE DIVOIRE SAO TOME AND PFIINCIPE DEMOCRATIe REPU8LiC THE COI~GO SENEGAL DJIBOUTI SEYCHELLES EQUATORIAL GUINEA SIERRA LeoNE

$OMAIJA ETHIOPIA SOUTH AFRICA GABON SWAZILAND C~AM8IA TOGO GHANA UGANDA GUINEA UNITED OF T ANZANIA

ZAMBIA KEumlNYA

ASIA AND THE PACIFIe - 39 Member Stateacutes

NAUFiU NEPAL

CAMBODIA BHUTAN

NIUE

COOK PALAU DEMOCRATIe PEOPLE S OF KOREA PAKiSTAN FlJI PAPUA NEW GUINEumlA INDrA PI-lILIPPINESmiddot INDONESfA REPUBtIC OF IRAN (ISLAIVlIC SAMOA KAZAKHSTAN SOlOMON ISLANDS KIRIBATI SRI LANKA KYRGYZ$TAN TAJIK1STAN LAO PEOPLes DEMOCRTIC EPU8LIC THA1LA~~D

MALAYSll~ TIMOR LESTE MALDIVES TONGA MARSHALL ISLANDS TURKMENI ST AN MICRONE$IA STATES OF) TUVALU MONGOUA UZBEKSTAN MYAMAR VAIlUATU

ViEf NAM

FROM PHOt-JE NO IcirclRY 18 2016 05 mPIl p~)

ARPa STATES -13 Motribef States

ALGERiA EGYPT IRAQ

lEBANON UBYiA MAURtiANIA

1v10fiOCCO PALESTINE SUDAN SYHIAN l~RAB REPUBUC TUNSIA YEMEN

LATIN AMERICAANO THE CARI8BEAN - 26 flilember States

ARGENTINA GUYANA BEumlUZE HAITI BOLlVIA HON DUHS BRAZIL JAMAICA

MEXICO COstA RICA NICARAGUt CUBA PANAMA DOMiNfCA PARAGUlY DOM1N1CAN REPU BUG PEJ~U ECUADOR SAINT LUCIA EL SALVADOR SAINT VNCENT AND THE GRENADA GUATEMALA SURINAME

VEN EZUEtA

EUROPE AND NORTH AiVlE~CA 12 Member States

ALBANIA REPU8L1C MOLDOV~ AI=lMENIA TriE FORMER

REPUBLC OF

BOSNIA AND HER2EGOVINA MONTENE(iRO P()LAND

GEORGiA SER81A UIltRAINE

PHOt-lE NO MAY 18 201E 05 03PI1 P4FROll

ANNEumlX 1

UNESCOJPEOPLES REUBLIC or CHINA (THE GREAT WALL)

CQ-SPONSORED FELLOWSHIPS PROGRAMME 2016-2017

With ltil view to rlr(rnl~tmiddot lleld of educatIon cuitUle communication science and among peopies of the world the Government ofthe at the disposa of for the aoademic 201 7 feHowships for adval1ced etudies agravet underwaduacircte and are for the b~nefjt of Mernber States in Alab Mnex 1)

The fellowships et El nurnber or universIcircties are far a dumtion of one lhase feJlowships whioh are ln moi cases 10 be concluoted in are offered to advanced sltJderits wishrog te pu(sue studies or intfmding to undertake individual rsearch with periodic guidance Trom the supervrsoL ln exceptional cases candidates may Mt to study in their fields of interest

A FIELDS Or PROPOSEO AT SELECTED UNIVERSITIES

Pfease vsit tf1e official web Couneil (CSe) for the fielos of proposed etudies at theacute se13CHQ unlvelsities

8 QUALIFICATIONS REQUIREO

(i) Se lmder 45 and hold et lea$t Bact)l~lors orthe or the Mastel when applying~

la required of age and

(iv) physicallyand

c PROCEDURE THE SUBMISSION or APPUCATIONS

Ail applications should be endorsE1d by the relevant Govrnment Mdy Natorrai Commission or Permanent Delegation) and must 1)19 pfGpagravered in wicirctll the following attacl)tnents

m AppHeation forms for ChinaUNESCO The GreacuteatWa1 Fellow$hip Complete the online at CSC Online Application -ltrom

for International at number 00001 and

cf diplomas and certificat t and solool-certifiedaoademIcirco reC()Ids (translated ln when

(Iv) letter 1rom university if av we - lt

(v) Two eUers of recommf1nclation (in or assoccediliales famiiar with the wor of the candiltlat$

PHDNE NO

~i oJ f

(vi) or researcli proposaI 400 words study 0 be

(vii) Exarnlnatloll lorTn to he and Or

certiflcate stamped andor

WMef (ompletil1g thi forrn Olch Gandiclale j$ ltl~ hosl instItutions ill ChficirclZl indicating one field of wish visl( the web of China ScholarslIip Council llliddJiilwc-hlt~1-i~~i 111lt in Chin2 tli) on ile ot the p~ge agravend refero the m tho 5lieoted Ms illstiiUllons

0- SUBMISSION OF CANDIDATURES

Letters of nomination and ai trle appliC1atiOns should I)e addreSSfd in to Mr Bantchev Chief orthe and -IIlt1Vl

7 Place de 7535~2 Plris 07 SP Fnmce and feach LI NESCD by 20 May at the An adv(jlice application wIcircln ail documents should be send acircS earliec as eurornail to

~~~~i_C( (ln d ----=~==~I files which art Ilot complete or which are receiv(~d after th above deadlin as wel as candidates gtho do no( filmll thiJ abovemiddotmentioned will net be taken into consideratiotl

E OF BENEFICARIES

auttlOritiecircs will $fleccedilt U10 (75) m05t nnmi~ci(~n~ of the $eleGtsd felloVls will be informed by

Mot nfonm~d by 31 July 201 i1 shou[c1 COnsider that their llJliJUI have Ilot bOecircn acircpproved

F SY THE nif PEOPLES

(n A morHhlY allowance of eNV 3000 for scholars or eNV 3500 for senior scholars will be meal$ and

Tuition waver

Accommodation 1ree university or accommodation If the 1-10St requinf$ students 10 live an campus the university will accommodats students in dormitory (usllaHy tWln

if the llest university studegravents ta off campus university will provide quarterly accommodarIcircon 5ubsidy

eNY 700 rnonth

(Iv) Meacutedicallnsurancemiddot1O and PrCtoctfon Scherne [(Ir lnt~lrnatiarlll Students ln China

-Stuejelits Flocirc 10 GOVer a certain of expenStl Claim for compfilflcatlon wilh llfl relt~vint peym0nl be asked company accorciing to the insuf1llcQ articles_ iumlh( claim willnot be ltlccepted by the Icircnt1wllli(o C)lnpany

PHONE t-lO tlRY 18 2016 05 04PI1 PE

6 II il

G FftCIUTIES BY UNESCO

(i) Qlicirce round trip illternatlonal travel to and from Chinu

A monthly poeket allowance of use) 150 hundred and flfty US cloHars)

A tQrminatlOt1 allowance of USD 200 hundred US 10 cover egravexcess uggage charges at time of fellows reiurn to their home

n additiun teacute the living allowanrr by the Government of the of China

No aUowanceacute to finarice or Icircl1arried or mernbQrs will be grantcd

Note It is the National lt(Jthorities respollsibHity to (ilflSUre that arl candidates are duly ioformed of HII the above-mentioned conditions before the submission or appflcatiolls for the fellowships

FRDr1 PHOf-JE NO 11AY 18 201E 12JS04FI1 P7

~

cp IjH~~Iumll~~amplt~~ 4gt CHINA SCHOLARS1UPCOUNCIL

Vi(1Iq~H~1 7~b~lJI] Al jtffiM~aJm 9 1 AH3 100044 ~~~~~------~~---~-shyNo 9 ~3middot13 chlgongzhlang Street Dcijlng rH( 1J-~t ~ ~J t middot _~k 1

~~~~~______-L~ ______PRChicircnal00044 T~l OOHamp-166093900 Bmiddotmail lllihuacsceducn

~jjf~tQ 1lnxOO8G-10-66093915 HttpIwwwcscc~hlcn 2 3

(The above table is only fer eSC)

rp ecirc$1 Damp M ~ ~ 1ft $ -ijf ~ APPLICATION FORM FOR CHINESE GOVERNMENT SCI-lIOLARSHIP

iljfl1JV A iflIJi~~~IlflJjHr~t iitlJfl ilifflIcirc~~~~IfI~~middot~~ WlIfl4nmGp~m~0~l ~WI~1 iAgraveLWlt7HI- Vgti i~i ampWillJllmYltJ~J Xmiddot ~ middot1ti09IIcirc~~iIampt5-~w1ix~ Pka~~ read rardilJJy lblt irrt~rtagravelugrave l)otes oc the la~t j)age before filling OUllhe (mm Please complete the form in Chinc~c or EI)lill I f th

(OrJI1 i$ not fllled in on PC plcau VtHe legihly in black ct blue ink PltIlsc indidlte with X in the oIan ccedilhosen AIl) forms IlIrn do n~middott follow the not~ will he invalid

1 IR AtmSUPersonallnformation

tp fuuml~ 8Passp0n Name )(U~shy

~Fumily Nune __________ __ _______ _____ PhUltl

~Given Name _--____~____

ffil~Nationality ~~__ lIh ft ~fllPassporl No ~_______

1 ~ El Jl1lIDatc of Birth~ FtYear Jj Molllh Fl (Day____

il ~+lm1Placc of Birlh ~ ~Counlry 9ampiumlicircCity_______

tt$Male 0 ~Fe~ole 0 B~fMarriJd 0 ~SUgravelgJC 0 JCcediliOthet 0 -BtiacircNacivc LaCguage___________ ~Religi(Jn________

_~jj~-lI fjUt(ltllPrescnt Address -------------~-_shy

E-mail ___~__bullbull_~____~ifiumlrrcl

AltAgraveial1~tilihlPerIl1allCIlt Address _---___~__

2 ft ~ffHH2Educa tion Bi1ckglOunl

$~ ~ampHM E ~1t ~J 1~~lhiE -I~ amp~ticirc iiE I Institutions Ytagraven At IClldccedild F~lds of Study Crlifilt1I1tS ObtiIIcircI1Uor

(fromtD) Tb Oblain

__~----shy

3 Trt~)JjEmploymcni Record T11 41amp ~Jfll1rBJ )A~Tf) ll s)lramp~g~ employer Timo (Irom(traquo Work Engagccedild PO$tRHcld

------- - _-_---shy

PHOt-lE NO MAY 18 201E 05 03PI1 P4FROll

ANNEumlX 1

UNESCOJPEOPLES REUBLIC or CHINA (THE GREAT WALL)

CQ-SPONSORED FELLOWSHIPS PROGRAMME 2016-2017

With ltil view to rlr(rnl~tmiddot lleld of educatIon cuitUle communication science and among peopies of the world the Government ofthe at the disposa of for the aoademic 201 7 feHowships for adval1ced etudies agravet underwaduacircte and are for the b~nefjt of Mernber States in Alab Mnex 1)

The fellowships et El nurnber or universIcircties are far a dumtion of one lhase feJlowships whioh are ln moi cases 10 be concluoted in are offered to advanced sltJderits wishrog te pu(sue studies or intfmding to undertake individual rsearch with periodic guidance Trom the supervrsoL ln exceptional cases candidates may Mt to study in their fields of interest

A FIELDS Or PROPOSEO AT SELECTED UNIVERSITIES

Pfease vsit tf1e official web Couneil (CSe) for the fielos of proposed etudies at theacute se13CHQ unlvelsities

8 QUALIFICATIONS REQUIREO

(i) Se lmder 45 and hold et lea$t Bact)l~lors orthe or the Mastel when applying~

la required of age and

(iv) physicallyand

c PROCEDURE THE SUBMISSION or APPUCATIONS

Ail applications should be endorsE1d by the relevant Govrnment Mdy Natorrai Commission or Permanent Delegation) and must 1)19 pfGpagravered in wicirctll the following attacl)tnents

m AppHeation forms for ChinaUNESCO The GreacuteatWa1 Fellow$hip Complete the online at CSC Online Application -ltrom

for International at number 00001 and

cf diplomas and certificat t and solool-certifiedaoademIcirco reC()Ids (translated ln when

(Iv) letter 1rom university if av we - lt

(v) Two eUers of recommf1nclation (in or assoccediliales famiiar with the wor of the candiltlat$

PHDNE NO

~i oJ f

(vi) or researcli proposaI 400 words study 0 be

(vii) Exarnlnatloll lorTn to he and Or

certiflcate stamped andor

WMef (ompletil1g thi forrn Olch Gandiclale j$ ltl~ hosl instItutions ill ChficirclZl indicating one field of wish visl( the web of China ScholarslIip Council llliddJiilwc-hlt~1-i~~i 111lt in Chin2 tli) on ile ot the p~ge agravend refero the m tho 5lieoted Ms illstiiUllons

0- SUBMISSION OF CANDIDATURES

Letters of nomination and ai trle appliC1atiOns should I)e addreSSfd in to Mr Bantchev Chief orthe and -IIlt1Vl

7 Place de 7535~2 Plris 07 SP Fnmce and feach LI NESCD by 20 May at the An adv(jlice application wIcircln ail documents should be send acircS earliec as eurornail to

~~~~i_C( (ln d ----=~==~I files which art Ilot complete or which are receiv(~d after th above deadlin as wel as candidates gtho do no( filmll thiJ abovemiddotmentioned will net be taken into consideratiotl

E OF BENEFICARIES

auttlOritiecircs will $fleccedilt U10 (75) m05t nnmi~ci(~n~ of the $eleGtsd felloVls will be informed by

Mot nfonm~d by 31 July 201 i1 shou[c1 COnsider that their llJliJUI have Ilot bOecircn acircpproved

F SY THE nif PEOPLES

(n A morHhlY allowance of eNV 3000 for scholars or eNV 3500 for senior scholars will be meal$ and

Tuition waver

Accommodation 1ree university or accommodation If the 1-10St requinf$ students 10 live an campus the university will accommodats students in dormitory (usllaHy tWln

if the llest university studegravents ta off campus university will provide quarterly accommodarIcircon 5ubsidy

eNY 700 rnonth

(Iv) Meacutedicallnsurancemiddot1O and PrCtoctfon Scherne [(Ir lnt~lrnatiarlll Students ln China

-Stuejelits Flocirc 10 GOVer a certain of expenStl Claim for compfilflcatlon wilh llfl relt~vint peym0nl be asked company accorciing to the insuf1llcQ articles_ iumlh( claim willnot be ltlccepted by the Icircnt1wllli(o C)lnpany

PHONE t-lO tlRY 18 2016 05 04PI1 PE

6 II il

G FftCIUTIES BY UNESCO

(i) Qlicirce round trip illternatlonal travel to and from Chinu

A monthly poeket allowance of use) 150 hundred and flfty US cloHars)

A tQrminatlOt1 allowance of USD 200 hundred US 10 cover egravexcess uggage charges at time of fellows reiurn to their home

n additiun teacute the living allowanrr by the Government of the of China

No aUowanceacute to finarice or Icircl1arried or mernbQrs will be grantcd

Note It is the National lt(Jthorities respollsibHity to (ilflSUre that arl candidates are duly ioformed of HII the above-mentioned conditions before the submission or appflcatiolls for the fellowships

FRDr1 PHOf-JE NO 11AY 18 201E 12JS04FI1 P7

~

cp IjH~~Iumll~~amplt~~ 4gt CHINA SCHOLARS1UPCOUNCIL

Vi(1Iq~H~1 7~b~lJI] Al jtffiM~aJm 9 1 AH3 100044 ~~~~~------~~---~-shyNo 9 ~3middot13 chlgongzhlang Street Dcijlng rH( 1J-~t ~ ~J t middot _~k 1

~~~~~______-L~ ______PRChicircnal00044 T~l OOHamp-166093900 Bmiddotmail lllihuacsceducn

~jjf~tQ 1lnxOO8G-10-66093915 HttpIwwwcscc~hlcn 2 3

(The above table is only fer eSC)

rp ecirc$1 Damp M ~ ~ 1ft $ -ijf ~ APPLICATION FORM FOR CHINESE GOVERNMENT SCI-lIOLARSHIP

iljfl1JV A iflIJi~~~IlflJjHr~t iitlJfl ilifflIcirc~~~~IfI~~middot~~ WlIfl4nmGp~m~0~l ~WI~1 iAgraveLWlt7HI- Vgti i~i ampWillJllmYltJ~J Xmiddot ~ middot1ti09IIcirc~~iIampt5-~w1ix~ Pka~~ read rardilJJy lblt irrt~rtagravelugrave l)otes oc the la~t j)age before filling OUllhe (mm Please complete the form in Chinc~c or EI)lill I f th

(OrJI1 i$ not fllled in on PC plcau VtHe legihly in black ct blue ink PltIlsc indidlte with X in the oIan ccedilhosen AIl) forms IlIrn do n~middott follow the not~ will he invalid

1 IR AtmSUPersonallnformation

tp fuuml~ 8Passp0n Name )(U~shy

~Fumily Nune __________ __ _______ _____ PhUltl

~Given Name _--____~____

ffil~Nationality ~~__ lIh ft ~fllPassporl No ~_______

1 ~ El Jl1lIDatc of Birth~ FtYear Jj Molllh Fl (Day____

il ~+lm1Placc of Birlh ~ ~Counlry 9ampiumlicircCity_______

tt$Male 0 ~Fe~ole 0 B~fMarriJd 0 ~SUgravelgJC 0 JCcediliOthet 0 -BtiacircNacivc LaCguage___________ ~Religi(Jn________

_~jj~-lI fjUt(ltllPrescnt Address -------------~-_shy

E-mail ___~__bullbull_~____~ifiumlrrcl

AltAgraveial1~tilihlPerIl1allCIlt Address _---___~__

2 ft ~ffHH2Educa tion Bi1ckglOunl

$~ ~ampHM E ~1t ~J 1~~lhiE -I~ amp~ticirc iiE I Institutions Ytagraven At IClldccedild F~lds of Study Crlifilt1I1tS ObtiIIcircI1Uor

(fromtD) Tb Oblain

__~----shy

3 Trt~)JjEmploymcni Record T11 41amp ~Jfll1rBJ )A~Tf) ll s)lramp~g~ employer Timo (Irom(traquo Work Engagccedild PO$tRHcld

------- - _-_---shy

PHDNE NO

~i oJ f

(vi) or researcli proposaI 400 words study 0 be

(vii) Exarnlnatloll lorTn to he and Or

certiflcate stamped andor

WMef (ompletil1g thi forrn Olch Gandiclale j$ ltl~ hosl instItutions ill ChficirclZl indicating one field of wish visl( the web of China ScholarslIip Council llliddJiilwc-hlt~1-i~~i 111lt in Chin2 tli) on ile ot the p~ge agravend refero the m tho 5lieoted Ms illstiiUllons

0- SUBMISSION OF CANDIDATURES

Letters of nomination and ai trle appliC1atiOns should I)e addreSSfd in to Mr Bantchev Chief orthe and -IIlt1Vl

7 Place de 7535~2 Plris 07 SP Fnmce and feach LI NESCD by 20 May at the An adv(jlice application wIcircln ail documents should be send acircS earliec as eurornail to

~~~~i_C( (ln d ----=~==~I files which art Ilot complete or which are receiv(~d after th above deadlin as wel as candidates gtho do no( filmll thiJ abovemiddotmentioned will net be taken into consideratiotl

E OF BENEFICARIES

auttlOritiecircs will $fleccedilt U10 (75) m05t nnmi~ci(~n~ of the $eleGtsd felloVls will be informed by

Mot nfonm~d by 31 July 201 i1 shou[c1 COnsider that their llJliJUI have Ilot bOecircn acircpproved

F SY THE nif PEOPLES

(n A morHhlY allowance of eNV 3000 for scholars or eNV 3500 for senior scholars will be meal$ and

Tuition waver

Accommodation 1ree university or accommodation If the 1-10St requinf$ students 10 live an campus the university will accommodats students in dormitory (usllaHy tWln

if the llest university studegravents ta off campus university will provide quarterly accommodarIcircon 5ubsidy

eNY 700 rnonth

(Iv) Meacutedicallnsurancemiddot1O and PrCtoctfon Scherne [(Ir lnt~lrnatiarlll Students ln China

-Stuejelits Flocirc 10 GOVer a certain of expenStl Claim for compfilflcatlon wilh llfl relt~vint peym0nl be asked company accorciing to the insuf1llcQ articles_ iumlh( claim willnot be ltlccepted by the Icircnt1wllli(o C)lnpany

PHONE t-lO tlRY 18 2016 05 04PI1 PE

6 II il

G FftCIUTIES BY UNESCO

(i) Qlicirce round trip illternatlonal travel to and from Chinu

A monthly poeket allowance of use) 150 hundred and flfty US cloHars)

A tQrminatlOt1 allowance of USD 200 hundred US 10 cover egravexcess uggage charges at time of fellows reiurn to their home

n additiun teacute the living allowanrr by the Government of the of China

No aUowanceacute to finarice or Icircl1arried or mernbQrs will be grantcd

Note It is the National lt(Jthorities respollsibHity to (ilflSUre that arl candidates are duly ioformed of HII the above-mentioned conditions before the submission or appflcatiolls for the fellowships

FRDr1 PHOf-JE NO 11AY 18 201E 12JS04FI1 P7

~

cp IjH~~Iumll~~amplt~~ 4gt CHINA SCHOLARS1UPCOUNCIL

Vi(1Iq~H~1 7~b~lJI] Al jtffiM~aJm 9 1 AH3 100044 ~~~~~------~~---~-shyNo 9 ~3middot13 chlgongzhlang Street Dcijlng rH( 1J-~t ~ ~J t middot _~k 1

~~~~~______-L~ ______PRChicircnal00044 T~l OOHamp-166093900 Bmiddotmail lllihuacsceducn

~jjf~tQ 1lnxOO8G-10-66093915 HttpIwwwcscc~hlcn 2 3

(The above table is only fer eSC)

rp ecirc$1 Damp M ~ ~ 1ft $ -ijf ~ APPLICATION FORM FOR CHINESE GOVERNMENT SCI-lIOLARSHIP

iljfl1JV A iflIJi~~~IlflJjHr~t iitlJfl ilifflIcirc~~~~IfI~~middot~~ WlIfl4nmGp~m~0~l ~WI~1 iAgraveLWlt7HI- Vgti i~i ampWillJllmYltJ~J Xmiddot ~ middot1ti09IIcirc~~iIampt5-~w1ix~ Pka~~ read rardilJJy lblt irrt~rtagravelugrave l)otes oc the la~t j)age before filling OUllhe (mm Please complete the form in Chinc~c or EI)lill I f th

(OrJI1 i$ not fllled in on PC plcau VtHe legihly in black ct blue ink PltIlsc indidlte with X in the oIan ccedilhosen AIl) forms IlIrn do n~middott follow the not~ will he invalid

1 IR AtmSUPersonallnformation

tp fuuml~ 8Passp0n Name )(U~shy

~Fumily Nune __________ __ _______ _____ PhUltl

~Given Name _--____~____

ffil~Nationality ~~__ lIh ft ~fllPassporl No ~_______

1 ~ El Jl1lIDatc of Birth~ FtYear Jj Molllh Fl (Day____

il ~+lm1Placc of Birlh ~ ~Counlry 9ampiumlicircCity_______

tt$Male 0 ~Fe~ole 0 B~fMarriJd 0 ~SUgravelgJC 0 JCcediliOthet 0 -BtiacircNacivc LaCguage___________ ~Religi(Jn________

_~jj~-lI fjUt(ltllPrescnt Address -------------~-_shy

E-mail ___~__bullbull_~____~ifiumlrrcl

AltAgraveial1~tilihlPerIl1allCIlt Address _---___~__

2 ft ~ffHH2Educa tion Bi1ckglOunl

$~ ~ampHM E ~1t ~J 1~~lhiE -I~ amp~ticirc iiE I Institutions Ytagraven At IClldccedild F~lds of Study Crlifilt1I1tS ObtiIIcircI1Uor

(fromtD) Tb Oblain

__~----shy

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PHONE t-lO tlRY 18 2016 05 04PI1 PE

6 II il

G FftCIUTIES BY UNESCO

(i) Qlicirce round trip illternatlonal travel to and from Chinu

A monthly poeket allowance of use) 150 hundred and flfty US cloHars)

A tQrminatlOt1 allowance of USD 200 hundred US 10 cover egravexcess uggage charges at time of fellows reiurn to their home

n additiun teacute the living allowanrr by the Government of the of China

No aUowanceacute to finarice or Icircl1arried or mernbQrs will be grantcd

Note It is the National lt(Jthorities respollsibHity to (ilflSUre that arl candidates are duly ioformed of HII the above-mentioned conditions before the submission or appflcatiolls for the fellowships

FRDr1 PHOf-JE NO 11AY 18 201E 12JS04FI1 P7

~

cp IjH~~Iumll~~amplt~~ 4gt CHINA SCHOLARS1UPCOUNCIL

Vi(1Iq~H~1 7~b~lJI] Al jtffiM~aJm 9 1 AH3 100044 ~~~~~------~~---~-shyNo 9 ~3middot13 chlgongzhlang Street Dcijlng rH( 1J-~t ~ ~J t middot _~k 1

~~~~~______-L~ ______PRChicircnal00044 T~l OOHamp-166093900 Bmiddotmail lllihuacsceducn

~jjf~tQ 1lnxOO8G-10-66093915 HttpIwwwcscc~hlcn 2 3

(The above table is only fer eSC)

rp ecirc$1 Damp M ~ ~ 1ft $ -ijf ~ APPLICATION FORM FOR CHINESE GOVERNMENT SCI-lIOLARSHIP

iljfl1JV A iflIJi~~~IlflJjHr~t iitlJfl ilifflIcirc~~~~IfI~~middot~~ WlIfl4nmGp~m~0~l ~WI~1 iAgraveLWlt7HI- Vgti i~i ampWillJllmYltJ~J Xmiddot ~ middot1ti09IIcirc~~iIampt5-~w1ix~ Pka~~ read rardilJJy lblt irrt~rtagravelugrave l)otes oc the la~t j)age before filling OUllhe (mm Please complete the form in Chinc~c or EI)lill I f th

(OrJI1 i$ not fllled in on PC plcau VtHe legihly in black ct blue ink PltIlsc indidlte with X in the oIan ccedilhosen AIl) forms IlIrn do n~middott follow the not~ will he invalid

1 IR AtmSUPersonallnformation

tp fuuml~ 8Passp0n Name )(U~shy

~Fumily Nune __________ __ _______ _____ PhUltl

~Given Name _--____~____

ffil~Nationality ~~__ lIh ft ~fllPassporl No ~_______

1 ~ El Jl1lIDatc of Birth~ FtYear Jj Molllh Fl (Day____

il ~+lm1Placc of Birlh ~ ~Counlry 9ampiumlicircCity_______

tt$Male 0 ~Fe~ole 0 B~fMarriJd 0 ~SUgravelgJC 0 JCcediliOthet 0 -BtiacircNacivc LaCguage___________ ~Religi(Jn________

_~jj~-lI fjUt(ltllPrescnt Address -------------~-_shy

E-mail ___~__bullbull_~____~ifiumlrrcl

AltAgraveial1~tilihlPerIl1allCIlt Address _---___~__

2 ft ~ffHH2Educa tion Bi1ckglOunl

$~ ~ampHM E ~1t ~J 1~~lhiE -I~ amp~ticirc iiE I Institutions Ytagraven At IClldccedild F~lds of Study Crlifilt1I1tS ObtiIIcircI1Uor

(fromtD) Tb Oblain

__~----shy

3 Trt~)JjEmploymcni Record T11 41amp ~Jfll1rBJ )A~Tf) ll s)lramp~g~ employer Timo (Irom(traquo Work Engagccedild PO$tRHcld

------- - _-_---shy

FRDr1 PHOf-JE NO 11AY 18 201E 12JS04FI1 P7

~

cp IjH~~Iumll~~amplt~~ 4gt CHINA SCHOLARS1UPCOUNCIL

Vi(1Iq~H~1 7~b~lJI] Al jtffiM~aJm 9 1 AH3 100044 ~~~~~------~~---~-shyNo 9 ~3middot13 chlgongzhlang Street Dcijlng rH( 1J-~t ~ ~J t middot _~k 1

~~~~~______-L~ ______PRChicircnal00044 T~l OOHamp-166093900 Bmiddotmail lllihuacsceducn

~jjf~tQ 1lnxOO8G-10-66093915 HttpIwwwcscc~hlcn 2 3

(The above table is only fer eSC)

rp ecirc$1 Damp M ~ ~ 1ft $ -ijf ~ APPLICATION FORM FOR CHINESE GOVERNMENT SCI-lIOLARSHIP

iljfl1JV A iflIJi~~~IlflJjHr~t iitlJfl ilifflIcirc~~~~IfI~~middot~~ WlIfl4nmGp~m~0~l ~WI~1 iAgraveLWlt7HI- Vgti i~i ampWillJllmYltJ~J Xmiddot ~ middot1ti09IIcirc~~iIampt5-~w1ix~ Pka~~ read rardilJJy lblt irrt~rtagravelugrave l)otes oc the la~t j)age before filling OUllhe (mm Please complete the form in Chinc~c or EI)lill I f th

(OrJI1 i$ not fllled in on PC plcau VtHe legihly in black ct blue ink PltIlsc indidlte with X in the oIan ccedilhosen AIl) forms IlIrn do n~middott follow the not~ will he invalid

1 IR AtmSUPersonallnformation

tp fuuml~ 8Passp0n Name )(U~shy

~Fumily Nune __________ __ _______ _____ PhUltl

~Given Name _--____~____

ffil~Nationality ~~__ lIh ft ~fllPassporl No ~_______

1 ~ El Jl1lIDatc of Birth~ FtYear Jj Molllh Fl (Day____

il ~+lm1Placc of Birlh ~ ~Counlry 9ampiumlicircCity_______

tt$Male 0 ~Fe~ole 0 B~fMarriJd 0 ~SUgravelgJC 0 JCcediliOthet 0 -BtiacircNacivc LaCguage___________ ~Religi(Jn________

_~jj~-lI fjUt(ltllPrescnt Address -------------~-_shy

E-mail ___~__bullbull_~____~ifiumlrrcl

AltAgraveial1~tilihlPerIl1allCIlt Address _---___~__

2 ft ~ffHH2Educa tion Bi1ckglOunl

$~ ~ampHM E ~1t ~J 1~~lhiE -I~ amp~ticirc iiE I Institutions Ytagraven At IClldccedild F~lds of Study Crlifilt1I1tS ObtiIIcircI1Uor

(fromtD) Tb Oblain

__~----shy

3 Trt~)JjEmploymcni Record T11 41amp ~Jfll1rBJ )A~Tf) ll s)lramp~g~ employer Timo (Irom(traquo Work Engagccedild PO$tRHcld

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FROM PHONE ~n

4 oo o

Level of HSK tegraveSt Of ~llher cerlificats which can show yOll

Chinegravese

a)fmiddot~JtJBaccedilhelors

Qf Field of Study in of Institutlons of flisher EduCagravetion ln China

5 i-tiJJPr~posed Slildy III Chilla

o Studellll 0

1 _______________ n __~_

d)$rJt~Y~~ ~ 1iumlJiumlfilDulatioll of the

ta the Major Study

fJ) Iif Yes picas indicirccatc the duration of your elementary ChitlMe study(nol Jntluded il the lenglh of the study)

ffiFrom

o

6 ( ~lfHH~) 1 Dcscribc the Detllils of your or R-seulh Plllll in Chilla (an extra pll~r C(lrl be Ilttamphcd if this spaœ ls notcnbugb)

7 amp Axt Worh Publisbcd

8 Applilld

A ScholalShip~D B ffl)1t~1f~JParlial Scholarship

~ttrrujtionO ~AccoiumodlitionO

9 the Vegrave)lIlltVil or

10 f~ Guaranlor -1~~u~YOΠCase in China

Hccommcndicircng you

$~rŒm~_~~~~________

~ccedilh sel UfU1C

llA tG 201 b 05 05pr1 PSIPHONE NO

qnVt ARj

~YesO

cr

you ever Sludied or Worked in China

~lJIllTEII~Il1~1U)iiUUlLlllfl or

IcircnChinll

12 fT ~ AgraverMfjlf(StFamily Melllotts of the Applic3Il t

illtrdi Nsme EmploYDem

iiegraveJmSpQ1Jh~ ______

X~(Faher ~_________

o

m~~l1~(eacute=m~mft=1li~ x ~l)3)IMH~riaI8 AllAcbed (flt~$lt JmJitllle wilb x in the Briicket) o lfllW~ ( ) Apj)liCagraveLion Form (in dupIiCllle) o ~1Iirs of ReCOllllllelldUUgraveQIl o ri Lmer or Admission NOlice of Cllinese UlIYerstie~ o AQ~~JJj~ampl1piUnmiddotfq (~i liE bull IIbnscriplsof Illt MOI Aegravevall)td Sttldicirces Ph01()CPY)

-jij)t) IOiplccedilroil of Ucirc1I MOi Augravevanœd SluqIcircCS (NOIMiwd lh()lIgtcoPY)

o 0 Jt9plusmnfDoctors 0 JttlOmcrs Cl o ilHlilAgraveff~ttmiliumlI (1El14) 1 PllyGiC41 EMmination For (PlIOIltlltOpy) o OjW SI1tly Plan in ChinB o or Pilpers Wrimo

Finemiddot Arts and Music)

or Cl ~~tF~~ ) ~Jfdf-Jlt lJ( Jf ( gt[J filJ Ffiiii A ) flLxilllpkf

of Ar (6 colot pillMes) aHI Music (i 2tldio

OJt~Ii(N~ (lilf~1fj) IQLhcTAttftchmen5 (LIcirciI Nedod) _~__ ~~------- ---------

Hl icirclff)-flinlfHIcirc~middotF~1egravet 20G A4 M flHlterials shooll not cllttted 20 pRge$ Pleasccedil lS~ DI A4

Jjamp If iWtH4PJ l ili lE egraveneacircgt tlte ICcedilCOpleagrave or Mt all too nppliclllOIl Mlellals wH 1101 lie relrncd

~~rAgrave1i_UEII H~ltby Affilm TuH 1 ~_1tfli~~IY~ttlaquo)(euroi~

Ali infOflnalioo and mareriumlalSgivcn in rorm lUe truti LOO OOnccedil

2 tt~fMitll ~tfJrdtifii flM~middotffffJfUicirc~i1im~tlltiffJ Durloamp slay China r shIlllllold hl th IIIW5 aoo of tlll Cilincse in imy activilios 11 Cliira arc deemed la he ~dver$ le the sodal n a Slll1eot

J middot~~HKM CSC rr3egravefiegraveiJ~~~ampfI1~JJfr will agrccedil 10 th of m) iftitIcirclulIumloll and specilllly or SlUoy iti ChIcircoo l1~Oe 0) CSC and will nul npply for ~11) rongeS ln thCi( Iwo fitlds valid rcas()n~

4ttliumll Agrave~J3ftll1lfUfti ~m~llln(~+tJlPl ~tud) r hall bide th Mcs and re2PLtti(lt~ oftle hoot university and wnccmrme (ln Illy smdies am r~sealctllt

an(J ti)~cllIcircng ptLgtgIarns rurilllgcd by the uiliverity 5 t(HiI~)j9bfl9middotr~ilJfrjt~tJlj

Ilih~l1 go UU(lugn the of [ne Mlll~l Rcvillw of Chine$ OovemllWIi( ShQlarShip Satuli as r~Quired () fti11ll [[ [il bull

1shall retllrn ta my home roumry as $0011 as 1complete IllY eacute1Jldul~d prugrave~r~1ll ln China and will nol llxWnd my Hlly middotitwul v~lid reasoo

7

jf 1am judg~d by (Ile alin~ccedil laws alld deltrees and the ruleacute~ and regu1(1[OrS of tne will riOmiddot loaSt Qly ~ppeltll Ihe dedsioll (lf CSC on wspendilll or wilhllrawinj my srh(I~Nhin

El

~ccedilh sel UfU1C

llA tG 201 b 05 05pr1 PSIPHONE NO

qnVt ARj

~YesO

cr

you ever Sludied or Worked in China

~lJIllTEII~Il1~1U)iiUUlLlllfl or

IcircnChinll

12 fT ~ AgraverMfjlf(StFamily Melllotts of the Applic3Il t

illtrdi Nsme EmploYDem

iiegraveJmSpQ1Jh~ ______

X~(Faher ~_________

o

m~~l1~(eacute=m~mft=1li~ x ~l)3)IMH~riaI8 AllAcbed (flt~$lt JmJitllle wilb x in the Briicket) o lfllW~ ( ) Apj)liCagraveLion Form (in dupIiCllle) o ~1Iirs of ReCOllllllelldUUgraveQIl o ri Lmer or Admission NOlice of Cllinese UlIYerstie~ o AQ~~JJj~ampl1piUnmiddotfq (~i liE bull IIbnscriplsof Illt MOI Aegravevall)td Sttldicirces Ph01()CPY)

-jij)t) IOiplccedilroil of Ucirc1I MOi Augravevanœd SluqIcircCS (NOIMiwd lh()lIgtcoPY)

o 0 Jt9plusmnfDoctors 0 JttlOmcrs Cl o ilHlilAgraveff~ttmiliumlI (1El14) 1 PllyGiC41 EMmination For (PlIOIltlltOpy) o OjW SI1tly Plan in ChinB o or Pilpers Wrimo

Finemiddot Arts and Music)

or Cl ~~tF~~ ) ~Jfdf-Jlt lJ( Jf ( gt[J filJ Ffiiii A ) flLxilllpkf

of Ar (6 colot pillMes) aHI Music (i 2tldio

OJt~Ii(N~ (lilf~1fj) IQLhcTAttftchmen5 (LIcirciI Nedod) _~__ ~~------- ---------

Hl icirclff)-flinlfHIcirc~middotF~1egravet 20G A4 M flHlterials shooll not cllttted 20 pRge$ Pleasccedil lS~ DI A4

Jjamp If iWtH4PJ l ili lE egraveneacircgt tlte ICcedilCOpleagrave or Mt all too nppliclllOIl Mlellals wH 1101 lie relrncd

~~rAgrave1i_UEII H~ltby Affilm TuH 1 ~_1tfli~~IY~ttlaquo)(euroi~

Ali infOflnalioo and mareriumlalSgivcn in rorm lUe truti LOO OOnccedil

2 tt~fMitll ~tfJrdtifii flM~middotffffJfUicirc~i1im~tlltiffJ Durloamp slay China r shIlllllold hl th IIIW5 aoo of tlll Cilincse in imy activilios 11 Cliira arc deemed la he ~dver$ le the sodal n a Slll1eot

J middot~~HKM CSC rr3egravefiegraveiJ~~~ampfI1~JJfr will agrccedil 10 th of m) iftitIcirclulIumloll and specilllly or SlUoy iti ChIcircoo l1~Oe 0) CSC and will nul npply for ~11) rongeS ln thCi( Iwo fitlds valid rcas()n~

4ttliumll Agrave~J3ftll1lfUfti ~m~llln(~+tJlPl ~tud) r hall bide th Mcs and re2PLtti(lt~ oftle hoot university and wnccmrme (ln Illy smdies am r~sealctllt

an(J ti)~cllIcircng ptLgtgIarns rurilllgcd by the uiliverity 5 t(HiI~)j9bfl9middotr~ilJfrjt~tJlj

Ilih~l1 go UU(lugn the of [ne Mlll~l Rcvillw of Chine$ OovemllWIi( ShQlarShip Satuli as r~Quired () fti11ll [[ [il bull

1shall retllrn ta my home roumry as $0011 as 1complete IllY eacute1Jldul~d prugrave~r~1ll ln China and will nol llxWnd my Hlly middotitwul v~lid reasoo

7

jf 1am judg~d by (Ile alin~ccedil laws alld deltrees and the ruleacute~ and regu1(1[OrS of tne will riOmiddot loaSt Qly ~ppeltll Ihe dedsioll (lf CSC on wspendilll or wilhllrawinj my srh(I~Nhin

El

---

FROM PHot~E NO MAY 18 2016 0506PM PiO

FOREIGNERPHYSICAL EXAMINAflON FORMUuml[middot-------- -~~IJ 0 jij Male middot-r---~JMHil1~1rr=~J9J Name~ 5()( D -k Pemale Birtndy

-~

~(rlHi1KJihl Present mailing llddress

f--- shy

~if~jtUl2 lli~tl mu Nadonality IJirth Blood type (or Area) place

i1M~JampWr~lj~~ (~~MJacirciumlfiii~~~ U~I ~ llJl1) Have you ever hM any of the foltowing disellscs

(t6ch item Ulu~t b agravell3wored Yes or No)

(J1fl~~ttffIampP~)

Photo

(Sltlmpcd Otliumliltd

Slamp)

ijE~ -m Typhu~ [evcr ONa OYes iicirc m Bacillary dysenlery 0-No OYes IlLJ~tW~ Poliomyelitis ONa OVe 1it~-1f~ B(ucell()~i~ 01ru [iYes tI ~ Dlph th cria ONu OYtli ~itJf~ Viral hepatitis ONe) OYes fM f1 ~~ Scarlet lever ONo OYes 1WJtrl_f$ Puerperal ~trep(Ococcus infectiOl)

lm ~J ft Relilp~rlg fever ONa OYes ~ ~ ~ Dl-lu Oy~

11ilm~~ljffl~ lyphoid and parnlyphoid fem ONo [JYts

WAIumlI~B~1tHmtlllt Epidemie CQrcbflspinal meningitis ONt) [JYc~ ------------~-~------~--------~~--------~~~--~~~~_--~-

~~RJ81~Jfcr2H~~tIJ~fII~1tucircltJ~~ (~_9icircniUiicircffl~ s ~ li )

DIl you hav( any of Ih~ following discues or dicircsorders clidangering the public order and secllrily

(Bach item must be answered Yes ()f No) ~IjfQ~ Toxicomania -- - ONu 0 Ycs ~P~Mi Mental-confusion ONo OVIIS

UW~ Psychosi~ ~JEm Manicpaychosis middotmiddot middot middotoNo Dtelgt ~~w Paran6id psycbosismiddot-middotmiddotmiddot middot ONo Oylt~

~Ieurom Hallucioatory - ONo OYc~

~---------~~-r--------------r---~--_-------~

t~ 1liD~ DiLl~ ~1tft Height CM J))ood prccedil~surccedil mmHg

----------------------~~-------------------+--~--------------~--~ ~~mw ~~ Developmem Neck

--------~-------------miS)] Colour sense

1+ tnH~i~ Tonsils

f-------- -~ _-----I----~ ----+------___~----Ear~

$l~egrave AbdomenHeurt

~____________________~______________--__L-______________- ______shy

FROl I~ESI~S FAX NO 13 20115 ESQ) P1

SPll1C

Wlllt

EXlremllies ~ystem

Othcr abnorrnal mYluij

r4tfffM~Jf Chest Xray exam

(allached ch~ X-ray report)

4tMt1iU~ltt (1111fgtt$~

~$~wrt~t) LaboratOTy exan1

(attached test report of AIDS Syphllis 61C)

tJJJilff-YJUcirc~~~~~i1l1tt~iU~M~~ None of the folloWIcircllg diSell5eS Qi rli$orden ~~und

bull BI Cholera iim _m Yelow fever

rtSf Plague

lIlPt Leprosy

the present LU

Venerelll Lung uberculosicircs

AlDS

Psycnosl

lt Sugraveggcstion Official

~yi1~ ( Signature or physician

SrJ Dale

FAX NO 19 l1a~i 2016 8 50 P2

f~~$middot~~~~ ~fi~ middot

amp United Nation$ Eduoallonal Soienlific ~d CuHurai Organizatiol1

7 pmce I~eacute Fontenoy 7~2 Parle 07 SP ttJephoncr (~1) 456a1000

APPLICATrON FOR ~alwQWSHIP

CERTIFICATE OF LANGUAmiddotGE J(NOWLEOGE

~---- Name of canaidalft middotmiddotmiddot middotM ~bullbull~ __ bullbullbull

_ _bull_ bullbull__bull- bullbullbull-----bullbullbull---bull---_bull_ bull_ bull ___bullbullbull__Langoagbull bullbull~- - - bullbull--bull-- _

-_shy-Addre~ of canclldate__ ___~_~ bull

___ _ _ _ _ h _ bullbull _ bull bull bullbull bull bullbull bull _ _ bull bullbull bull bull bull bullbull bullbullbullbull bull _ _ bull bull bull bullbull _ bullbullbullbull bullbull bull bull bull bullbullbullbull bull bullbullbullbullbull bull bull bullbull bull bull bullbull bull bull bullbullbullbull ~ bull bull bull bullbull bull

~----~------------------------------------------

(1) ABILITY TO UNDE~STAND

~)) ~~= W~~wh~~~r~a~oo~d 1ll1~ u ( 9 a1 gJ1 ng rasaed nlY aA cal~I1y bullbull middotmiddot sect

(c) ROquJramp8 fr~nt r~ ar4or l1anelatlOtl acirc IoIOfdg iI1d llI)tases middot (~) ~s not urd6tsWld IflOkIrI ~___ _ _ _ _

(2) A81L1TY TO 5PEAK

() - __-__--- ___ -- ~ -~ (b) Speaka IntalJlglbly but la Ct fue(t ()l ~t accural9bull middot middotmiddot middotmiddot middotmiddot

(0) sPeaks~ and ~ oftampn at Il Ioss 101 wolda and pIIrtlSell

(3 A61L1TY TO WAlTe

(a) Writ9S wllh oœe and alCUratatybull~ __ middotmiddot sect(bl Wrtles 81oW1y ~pf ~ oniy 1 moderale œwee 0 arccedilur8tC~ middot middotmiddotmiddot middotmiddotmiddotmiddotmiddotbull middot (c WIIl6S wIln cjl1tlccedilUlty ISIId makes l~~ mI~kas_ middotmiddot middotmiddotmiddotmiddotmiddot middotmiddotmiddotmiddot h bull

(4) REAOtNG ABILlTY AND COMPREHENSION

(il) A$Id$ flulaquoIy ~ full ecmpMlhllIllioil_middot middot middot middotmiddot middot sect (b) Reaœ s~ bUt ~~ ampYOI)1tWlg he roade ~ _ =3

(cl Reads wlth dlHlccedilully afld onty vtth freQlJlJnt ((l(JOUJ1(I te the ltIIacircIonalY (cl) Canot read __ _ ~middot middot middotmiddotmiddotmiddotmiddotmiddotmiddot ~

(5) TECHNICAl LANGUAGE CMain lelMlW6hlps reltJJlre a partiegravetilar knltlW1~ of spedAlzed 01 IlChnicallllnQl)aQe ln ampuch CcedilI$eS

ple1ti8 evakJm canaldatB3 ablllty with rilferenœ kl pagraveratl l 2 aM 4 abo~e

(6) PlGlSO l~t8 any funlgtier fooIs Abou candidalB~ 1an0UA08 kOONtedQe wt1iegraveh maybe of value in th

dovelOpmeM 01 hls ~raIIoIIIG

Jd~ _ ~ ~ o

LANGuAGE tEST HAS BEumlN MAaS 6Y __ 1

Nam6 _ _ 1 1

u o - - - bull

Ttlecirc _middotmiddot middotmiddotmiddotmiddot~middot middot middotmiddot middot - Oala bullmiddotmiddotbullbullmiddot middotmiddotmiddot middot middotmiddot - __ __bull ~ _

_ COM~ENrS__ 0_ _ _ __ _ -1 _ Tbullbullbull bull bull lmiddot middotmiddot middotmiddotmiddotmiddot _

1

- bullbullbullbull _ _ _ _ bullbull bull ~ middotHmiddot middot - bull

FROl I~ESI~S FAX NO 13 20115 ESQ) P1

SPll1C

Wlllt

EXlremllies ~ystem

Othcr abnorrnal mYluij

r4tfffM~Jf Chest Xray exam

(allached ch~ X-ray report)

4tMt1iU~ltt (1111fgtt$~

~$~wrt~t) LaboratOTy exan1

(attached test report of AIDS Syphllis 61C)

tJJJilff-YJUcirc~~~~~i1l1tt~iU~M~~ None of the folloWIcircllg diSell5eS Qi rli$orden ~~und

bull BI Cholera iim _m Yelow fever

rtSf Plague

lIlPt Leprosy

the present LU

Venerelll Lung uberculosicircs

AlDS

Psycnosl

lt Sugraveggcstion Official

~yi1~ ( Signature or physician

SrJ Dale

FAX NO 19 l1a~i 2016 8 50 P2

f~~$middot~~~~ ~fi~ middot

amp United Nation$ Eduoallonal Soienlific ~d CuHurai Organizatiol1

7 pmce I~eacute Fontenoy 7~2 Parle 07 SP ttJephoncr (~1) 456a1000

APPLICATrON FOR ~alwQWSHIP

CERTIFICATE OF LANGUAmiddotGE J(NOWLEOGE

~---- Name of canaidalft middotmiddotmiddot middotM ~bullbull~ __ bullbullbull

_ _bull_ bullbull__bull- bullbullbull-----bullbullbull---bull---_bull_ bull_ bull ___bullbullbull__Langoagbull bullbull~- - - bullbull--bull-- _

-_shy-Addre~ of canclldate__ ___~_~ bull

___ _ _ _ _ h _ bullbull _ bull bull bullbull bull bullbull bull _ _ bull bullbull bull bull bull bullbull bullbullbullbull bull _ _ bull bull bull bullbull _ bullbullbullbull bullbull bull bull bull bullbullbullbull bull bullbullbullbullbull bull bull bullbull bull bull bullbull bull bull bullbullbullbull ~ bull bull bull bullbull bull

~----~------------------------------------------

(1) ABILITY TO UNDE~STAND

~)) ~~= W~~wh~~~r~a~oo~d 1ll1~ u ( 9 a1 gJ1 ng rasaed nlY aA cal~I1y bullbull middotmiddot sect

(c) ROquJramp8 fr~nt r~ ar4or l1anelatlOtl acirc IoIOfdg iI1d llI)tases middot (~) ~s not urd6tsWld IflOkIrI ~___ _ _ _ _

(2) A81L1TY TO 5PEAK

() - __-__--- ___ -- ~ -~ (b) Speaka IntalJlglbly but la Ct fue(t ()l ~t accural9bull middot middotmiddot middotmiddot middotmiddot

(0) sPeaks~ and ~ oftampn at Il Ioss 101 wolda and pIIrtlSell

(3 A61L1TY TO WAlTe

(a) Writ9S wllh oœe and alCUratatybull~ __ middotmiddot sect(bl Wrtles 81oW1y ~pf ~ oniy 1 moderale œwee 0 arccedilur8tC~ middot middotmiddotmiddot middotmiddotmiddotmiddotmiddotbull middot (c WIIl6S wIln cjl1tlccedilUlty ISIId makes l~~ mI~kas_ middotmiddot middotmiddotmiddotmiddotmiddot middotmiddotmiddotmiddot h bull

(4) REAOtNG ABILlTY AND COMPREHENSION

(il) A$Id$ flulaquoIy ~ full ecmpMlhllIllioil_middot middot middot middotmiddot middot sect (b) Reaœ s~ bUt ~~ ampYOI)1tWlg he roade ~ _ =3

(cl Reads wlth dlHlccedilully afld onty vtth freQlJlJnt ((l(JOUJ1(I te the ltIIacircIonalY (cl) Canot read __ _ ~middot middot middotmiddotmiddotmiddotmiddotmiddotmiddot ~

(5) TECHNICAl LANGUAGE CMain lelMlW6hlps reltJJlre a partiegravetilar knltlW1~ of spedAlzed 01 IlChnicallllnQl)aQe ln ampuch CcedilI$eS

ple1ti8 evakJm canaldatB3 ablllty with rilferenœ kl pagraveratl l 2 aM 4 abo~e

(6) PlGlSO l~t8 any funlgtier fooIs Abou candidalB~ 1an0UA08 kOONtedQe wt1iegraveh maybe of value in th

dovelOpmeM 01 hls ~raIIoIIIG

Jd~ _ ~ ~ o

LANGuAGE tEST HAS BEumlN MAaS 6Y __ 1

Nam6 _ _ 1 1

u o - - - bull

Ttlecirc _middotmiddot middotmiddotmiddotmiddot~middot middot middotmiddot middot - Oala bullmiddotmiddotbullbullmiddot middotmiddotmiddot middot middotmiddot - __ __bull ~ _

_ COM~ENrS__ 0_ _ _ __ _ -1 _ Tbullbullbull bull bull lmiddot middotmiddot middotmiddotmiddotmiddot _

1

- bullbullbullbull _ _ _ _ bullbull bull ~ middotHmiddot middot - bull

FAX NO 19 l1a~i 2016 8 50 P2

f~~$middot~~~~ ~fi~ middot

amp United Nation$ Eduoallonal Soienlific ~d CuHurai Organizatiol1

7 pmce I~eacute Fontenoy 7~2 Parle 07 SP ttJephoncr (~1) 456a1000

APPLICATrON FOR ~alwQWSHIP

CERTIFICATE OF LANGUAmiddotGE J(NOWLEOGE

~---- Name of canaidalft middotmiddotmiddot middotM ~bullbull~ __ bullbullbull

_ _bull_ bullbull__bull- bullbullbull-----bullbullbull---bull---_bull_ bull_ bull ___bullbullbull__Langoagbull bullbull~- - - bullbull--bull-- _

-_shy-Addre~ of canclldate__ ___~_~ bull

___ _ _ _ _ h _ bullbull _ bull bull bullbull bull bullbull bull _ _ bull bullbull bull bull bull bullbull bullbullbullbull bull _ _ bull bull bull bullbull _ bullbullbullbull bullbull bull bull bull bullbullbullbull bull bullbullbullbullbull bull bull bullbull bull bull bullbull bull bull bullbullbullbull ~ bull bull bull bullbull bull

~----~------------------------------------------

(1) ABILITY TO UNDE~STAND

~)) ~~= W~~wh~~~r~a~oo~d 1ll1~ u ( 9 a1 gJ1 ng rasaed nlY aA cal~I1y bullbull middotmiddot sect

(c) ROquJramp8 fr~nt r~ ar4or l1anelatlOtl acirc IoIOfdg iI1d llI)tases middot (~) ~s not urd6tsWld IflOkIrI ~___ _ _ _ _

(2) A81L1TY TO 5PEAK

() - __-__--- ___ -- ~ -~ (b) Speaka IntalJlglbly but la Ct fue(t ()l ~t accural9bull middot middotmiddot middotmiddot middotmiddot

(0) sPeaks~ and ~ oftampn at Il Ioss 101 wolda and pIIrtlSell

(3 A61L1TY TO WAlTe

(a) Writ9S wllh oœe and alCUratatybull~ __ middotmiddot sect(bl Wrtles 81oW1y ~pf ~ oniy 1 moderale œwee 0 arccedilur8tC~ middot middotmiddotmiddot middotmiddotmiddotmiddotmiddotbull middot (c WIIl6S wIln cjl1tlccedilUlty ISIId makes l~~ mI~kas_ middotmiddot middotmiddotmiddotmiddotmiddot middotmiddotmiddotmiddot h bull

(4) REAOtNG ABILlTY AND COMPREHENSION

(il) A$Id$ flulaquoIy ~ full ecmpMlhllIllioil_middot middot middot middotmiddot middot sect (b) Reaœ s~ bUt ~~ ampYOI)1tWlg he roade ~ _ =3

(cl Reads wlth dlHlccedilully afld onty vtth freQlJlJnt ((l(JOUJ1(I te the ltIIacircIonalY (cl) Canot read __ _ ~middot middot middotmiddotmiddotmiddotmiddotmiddotmiddot ~

(5) TECHNICAl LANGUAGE CMain lelMlW6hlps reltJJlre a partiegravetilar knltlW1~ of spedAlzed 01 IlChnicallllnQl)aQe ln ampuch CcedilI$eS

ple1ti8 evakJm canaldatB3 ablllty with rilferenœ kl pagraveratl l 2 aM 4 abo~e

(6) PlGlSO l~t8 any funlgtier fooIs Abou candidalB~ 1an0UA08 kOONtedQe wt1iegraveh maybe of value in th

dovelOpmeM 01 hls ~raIIoIIIG

Jd~ _ ~ ~ o

LANGuAGE tEST HAS BEumlN MAaS 6Y __ 1

Nam6 _ _ 1 1

u o - - - bull

Ttlecirc _middotmiddot middotmiddotmiddotmiddot~middot middot middotmiddot middot - Oala bullmiddotmiddotbullbullmiddot middotmiddotmiddot middot middotmiddot - __ __bull ~ _

_ COM~ENrS__ 0_ _ _ __ _ -1 _ Tbullbullbull bull bull lmiddot middotmiddot middotmiddotmiddotmiddot _

1

- bullbullbullbull _ _ _ _ bullbull bull ~ middotHmiddot middot - bull