ASSESSMENT FORM
申 请 留 学 家 庭 经 济 情 况 评 估 表

DATE（日期）________________

NAME（姓名）__________________DOB（生日）____________SEX（性别）___
ADDRESS（家庭住址）__________________________________________________
TEL (住宅电话) ____________________ TEL (学校电话)_______________________
FAX（传真）______________________ CELL (移动电话) _____________________
EMAIL (电子邮件) ______________________________________________________
MARITAL STATUS（婚姻状况）_______ EDUCATION (文化程度) ____________
CURRENT SCHOOL (目前就读学校, 专业及年级) ____________________________

Father's Name (父亲姓名) ___________ Age (年龄) ____ Income (年收入) _______
Company (工作单位) _________________________________ Position (职务) ______

Mother's Name (母亲姓名) __________ Age (年龄) ____ Income (年收入) _______
Company (工作单位) _________________________________ Position (职务) ______

For Business Owner (若有自己的公司):
涉及 Father (父) ___ 和/或 Mother (母) ___ (请在适当的空格里打勾)
Company Name (公司名称) ________________________________________________
Registration Date (注册日期) _____________ Registered Capital (注册资金) ________
Shareholder's Equity (公司净资产) _______________ Ownership (所占股份) ______

CASH（银行存款）＄_________________ PROPERTY（房产）＄______________
BUSINESS（生意资产）＄________________ STOCKS（股票）＄______________ TOTAL（家庭总资产）＄__________________________

Other Financial Supporter (若由其他人作经济担保):
Name (姓名) __________________ Age (年龄) ____ Relationship (与本人关系) _____
Address (住址) __________________________________________________________
Tel (电话) __________________________ Fax (传真) __________________________
Company (工作单位) _____________________________________________________
Position (职务) __________ Income (年收入) _________ Cash (银行存款) _________

备注：填好后，请传真至本公司，001-416-2926340。

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