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[null,null,"中国科学院院级国际合作交流"]
[null,null,"            项  目  申  请  书"]
[]
[]
[null,null,null,"申请单位："]
[]
[null,null,null,"项目编号："]
[]
[]
[null,null,null,"中国科学院国际合作局印制"]
[]
[null,null,null,null,"二零零一年版"]

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[null,null,"国 际/港 澳 台 合 作 交 流 项 目 申 请 表"]
[]
["   第一部分：人机表"]
["申请单位",null,null,null,null,"机构编号"]
["项目编号",null,null,null,"项目级别",null,null,null,null,"项目类别"]
["交流形式"]
["项目(中)"]
["名称(英)"]
["项目学科"]
["项目性质"]
["项目类型"]
["院级协议"]
["国      别 或 地 区",null,null,null,null,"顺访国家     或  地  区"]
["主       要接待单位"]
["团组人数",null,null,"开始日期",null,null,null,"结束日期"]
["经费来源"]
["向院申请人民币",null,null,null,"元","所拟支持人民币",null,null,null,null,null,null,"元"]
["向院申请外汇额度",null,null,null,"美元","所拟提供外汇额度"]
["院    外     资     助"]
["国外资助(合美元)"]
["其     他"]
["国     籍","工    作    单    位",null,null,"姓     名","性别",null,"出生日期",null,"职      称",null,null,"职       务"]
[]
[]
[]
[]
["申请单位外事经办人及电话 申请单位所长签字并盖所章"]

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["第二部分：项目介绍及单位审批意见等"]
["一、申请理由："]
[null,"1. 申请人所承担的科研项目名称？属几级课题？项目编号？"]
[]
[]
[]
[]
[]
[null,"3. 本项目的内容和意义及与国内外研究水平的比较："]
[]
[]
[]
[]
[]
[]
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[]
[null,"3. 本项目取得的成果、获奖情况及国际合作交流情况："]

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["二、申请人对所承担的科研项目国际合作交流有何长远设想：申请的此项国际合作交流与长远设想的关系？"]
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["三、通过本项国际合作交流急需解决的主要问题？预期成果？"]

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[]
["四、申请参加国际会议填写此栏："]
[null,"1. 国际会议主办单位或发起单位："]
[]
[]
[]
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[]
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[null,"2. 邀请单位、邀请人及通讯地址，并附会议通知："]
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[]
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[null,"3. 该国际会议情况（讨论问题，有无一中一台问题）："]

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[]
["五、与本国际合作交流有关的双方主要科学家情况（姓名、性别、年龄、职称、工作单位，研究领域和成果，语种和水平）"]
[null,"1. 对方主要科学家情况："]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"2. 我方主要科学家情况："]

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[]
["六、本项目的实施方案（介绍具体合作交流计划，接待单位、工作形式与内容）"]
[]
[]
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[]
[]
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["七、本项国际合作交流，已执行多长时间？在执行期内何成果：（已批准并在执行中的院级项目填写此栏）"]

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["八：申请单位所长及学术委员会审查意见："]
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["                                                                                                                   日期："]
["学术委员会投票情况："]
[]
["同意：               票；          不同意：               票；         弃权：               票；"]
["所长签字：                                                    学术委员会主任签字："]
["九、国际合作局审查意见："]
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["局长签字：                                                                                             日期："]