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["附件2"]
["山东省政府自筹经费资助出国留学申请书"]
[]
[{"$nulls":13},"申请人近照   标准一寸、光纸、正面、免冠"]
["编号:□□□□□□□□□□ (由省教育厅或省人事厅统一编写)"]
["受理单位名称："]
[]
[]
[]
["1、申请人基本信息"]
["姓名(中文)",{"$nulls":5},"姓名(拼音)",{"$nulls":5},"性别",null,"民族"]
["出生日期",{"$nulls":5},"身份证号码"]
["现工作单位",{"$nulls":7},"地址"]
["邮政编码",{"$nulls":5},"行政职务",{"$nulls":3},"专业技术职务"]
["最后学历",{"$nulls":3},"毕业时间",{"$nulls":3},"获得学位",{"$nulls":3},"参加工作时间"]
["办公电话 ",{"$nulls":5},"移动电话",{"$nulls":5},"目前从事专业"]
["2、申请留学情况"]
["申请留学专业名称",{"$nulls":9},"所属学科领域"]
["具体研究方向",{"$nulls":9},"申请留学时间",null,null,"□6个月  □12个月"]
["是否属于资助重点",{"$nulls":3},"□是       □否",null,null,"申请留学国别1",{"$nulls":4},"申请留学国别2"]
["3、外语语种及水平",{"$nulls":9},"外语语种"]
["达标",null,null,"□外语专业本科毕业",{"$nulls":4},"□WSK考试合格"]
[{"$nulls":3},"□近十年内曾在同语种国家留学一学年或连续工作一年以上"]
["不达标",null,null,"□无WSK考试成绩",{"$nulls":4},"□参加WSK考试未达标"]
["WSK考试情况",null,null,"考试语种",{"$nulls":3},"考试日期",null,null,"总成绩",null,null,"听力成绩"]
["其他",null,null,"IELTS成绩",{"$nulls":3},"考试日期",null,null,"GRE成绩",null,null,"考试日期 "]
[{"$nulls":3},"TOEFL成绩",{"$nulls":3},"考试日期",null,null,"GMAT成绩",null,null,"考试日期 "]
["4、接受高等教育和在国内进修情况"]
["学校/单位名称",{"$nulls":5},"时间(自/至)",null,null,"主修专业/内容",{"$nulls":3},"所获学位或证书"]
[]
[]
[]
["5、如曾在境外学习/工作，请说明境外学习/工作情况"]
["国别/地区及所在机构名称",{"$nulls":5},"时间(自/至)",null,null,"经费来源",null,null,"学习专业",null,"使用语言"]
[]
[]
[]
["6、工作经历（可另附页）"]
[" 工作单位",{"$nulls":5},"时间(自/至)",null,null,"从事工作",{"$nulls":3},"技术职务/行政职务"]
[]
[]
[]
[]
["7、其他说明"]
["是否曾获得国家留学基金资助出国/国家公派留学？          ",{"$nulls":8},"□否  "," □是    次数：      次      时间 ：        年   "]
["是否曾获得过山东省政府自筹经费资助出国留学？   ",{"$nulls":8},"□否          "," □是    次数：      次      时间：         年 "]
["8、曾获得过的专利和学术成果、技术成果及获得奖励(请另附获奖证书复印件)"]
["专利、学术成果、技术成果或科技奖励名称",{"$nulls":9},"授予机关或等级",null,null,"时间","本人位次"]
[]
[]
[]
[]
[]
["9、最近5年出版的主要著作或发表的主要论文"]
["著作或论文名称",{"$nulls":9},"出版社或刊物名称",null,null,"时间","本人位次"]
[]
[]
[]
[]
[]
["10、拟留学专业（研究课题）在国内国外研究情况及水平，所在单位科研工作条件"]
{"$rows_empty":18}
["11、出国学习/研修目的及计划(600字以上；不得另附页)，主要内容应包括："]
["a.出国学习/研修目的及预期目标"]
["b.出国学习/研修计划"]
["c.实施本次出国学习/研修计划所需的时间及方法"]
["d.拟选择的留学国别、留学单位及选择原因（应简单评述对方国家及留学单位在申请人所从事学科、专业领域的水平、优势，申请人及所在单位与对方有无合作基础及业务联系。如已有邀请信，可提供复印件）"]
["e.完成国外学习/研修后，回国后工作/学习计划"]
{"$rows_empty":21}
["12、请结合本人目前从事的工作及掌握的专业技术知识，对达到本次出国学习/研修预期目标的可行性予以简要说明"]
{"$rows_empty":20}
["申    请    人    保    证"]
["    上述各项中所提供的情况真实无误。如被录取，本人保证遵守山东省政府自筹经费资助出国留学的各项规定，签订协议，履行有关义务，努力学习，按期学成回国服务。"]
[{"$nulls":10},"申请人签字："]
[{"$nulls":10},"日期：       年   月   日"]

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