Personal Information

Family name

Given name

Date of birth
(DD-MM-YYYY)

Nationality

Passport No.

Gender

Status

Undergraduate  Ph.D.  Bachelor  

Home institution

Advisor

School/Department

Mobile phone No.

Email

Contact address

Emergency contact and phone No.

Research Plan

Duration

6 weeks  8 weeks  

ShanghaiTech hosting school/institute

ShanghaiTech mentor

Please specify the research project that you intend to work on

Program expectation

Funding resource (please specify)

Signature

Date

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