Zhejiang Provincial Hospital of Chinese Medicine

Application Form For Admission

Passport Number:

Valid until:

Applicant's Family Name(must be same as passport):

Given Name(must be same as passport):

Gender:

Religion:

Marital Status:

Date of Birth:

for example:10/10/1999

Place of Birth:

Health Condition:

Nationality:

Occupation:

TCM Education Background/Qualification in TCM:

Home Address (actual mailing address for you to receive hard copies of application documents):

Post code:

Employer or Institute Affiliated:

Tel:

E-mail:

Highest Academic Degree Obtained:

Professional Experience:

TCM Acupuncture Tuina

Membership in Professional Societies:

First Language:

Second Language:

Expect subject of Training:

Prospective Duration of Training:

Estimate Arrival Date:

for example:10/10/1999

Room Required:

Double Single

Name of Chinese Embassy in your nearest city that you are going to apply visa:

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