浙江工商职业技术学院境外留学生信息表 zbti students Outside China Information Sheet

浙江工商职业技术学院境外留学生信息表

ZBTI Students Outside China Information Sheet
本人承诺如实提供以下信息，如有瞒报、谎报由本人承担经济与法律责任I promise that all information I provide is true. If there is any concealing or lie, I will take all the financial and legal liability.

1. 
   个人信息Personal Information
   

姓名Full Name: Mirzaliyev Umidjon Botirjon Ugli

中文名Chinese Name：吴炅

护照号Passport No: FA0561185

签证到期日期 Current Visa Expire Date: 2020.07.31

境外联系电话 Oversea Contact Number：[phone]

目前居住地址 Current Address：Uzbekistan Fergana region

同住人员 Whom do I live with currently: with parents

健康码 Health Code Color：green

2. 
   旅行史 Travel History
   

离校日期 Date of leaving Ningbo
日期Date	行程 Journey （including cities in China）
feb.3	Ningbo to Beijing
Feb.5-6	From Beijing to Tashkent

3. 
   流行病学史调查 Epidemiological History
   

1.你是否有出现发热、干咳等症状？Do you have fever, cough or other related symptoms?

□是Yes（如是，出现症状及时间 If yes，time and symptom ）

□否 No 

2.你是否接触过来自疫区的人？Have you contacted with people from epidemic area, such as Hubei Province, Korea, Japan, Italy, Iran, etc.?

□是Yes（如是，国家及时间 If yes，time and country ）

□否 No 

3. 周围人是否有发热、干咳症状或接触过来自疫区的人？Does anyone around you have fever or cough or contact people from epidemic area?

□是Yes（如是，提供详情 If yes，details ）

□否 No 

4. 
   学习计划 Study Plan
   

1. 是否计划回校继续学习Do you plan to continue your study at ZBTI?

□是Yes

□否 No

2. 计划回校时间 Rough date you plan to come back to school.

□疫情结束后After the epidemic ends 

□下个学期 Next Semester (in September)

□具体日期 Date
填表日期 Date of Filling 2020.03.12
以下由班主任填写 The following part is filled by the head teacher

联系时间	联系内容	联系人