IBM Visiting Scholars Program Application Form.doc

第 PAGE 6页，共6页 IBM Visiting Scholars Program Application Form Personal photo Please complete the form（except appendix I and II) in English I. General Information Name(Chinese) (Pinyin)_____________ Gender__________ Birthday(yy/mm/dd) Single/Married__________ Title of technical post Title__________________ Years of service in university_________________ University name _____________________________________________ Department name________________________________________________ Graduate university ____________________________________ University degree(ph.d, master)________________ University major ______________ Mail address__________________________________________________ Postcode Telephone( )- Fax___________ Cellphone____________ Email____________________________ II. General Visiting Plan Planned visiting date: from to_______________ Research directions Research plan Target research achievement III. Education status University nametimemajorUniversity degree and certificates IV. Foreign Language Level English__________(excellent, good, average, poor or indicate the certificate you have) Japanese__________(excellent, good, average, poor or indicate the certificate you have) Others__________(excellent, good, average, poor or indicate the certificate you have) V. Study and working experience outside China Country and institution/university nameStudy/working timeAny sponsor? From whom?Study/working directionsWorking language VI. Research experience in the past 5 years Research directionstimeMajor job roleResearch achievement