┃考试申请

世针针灸学会联合会国际针灸专业人员水平考试申请表

Application Form for International Qualification Test for Acupuncture and Moxibustion Practitioners of WFAS

NO.

报考专业(Specialized Subject of Examination):

2寸照片

1.姓名/Name:

2.性别/Sex:     男 (Male)      女 (Female): 

3.出生日期/Date of Birth:

报考语种/Language for Examination:

4.国籍或地区/Nationality or Region:

5.护照号/Passport No. :

6.通讯地址/Contact Address:

7.电话/Tel: 传真(Fax):

8.医/药、护理 学历/学位:Medical Education and Academic:

中专 Secondary School 大专 Junior College 本科 Junior College 硕士 Master Degree 博士 Doctor Degree

9.何时在何院校(或学术团体)学习中医(中药、中医护理)/ Studied TCM at what Time and which Organization (or Association) :

学习培训时数/Learning Hours:

临床实践时间/Practicing Hours:

10.从师学习/Studying TCM As an Apprentice:

指导医师姓名/ Master's Name:

国籍或地区/Nationalityor Region:

专业职务/Professional Position:

从事学习年限/Period of Apprenticeship:

临床实践时间/Practicing Hours:

从业多年,确有专长/Practicing Medicine for Many Years with Specialty:

11.从业年限/Practicing Years:

12.身份证明、学历证明(影印本)名称/Titles of Certificates ( duplicated copies ) for Reference :

1. 2. 3. 4.

申请人签字(Applicant's Signature):

世界针灸学会联合会资格考试部 World federation of Acupuncture and Moxibustion Societies Qualification Department
0.0566s