Formulario de Aplicación Beca Taiwan

臺灣獎學金申請表

APPLICATION FORM FOR TAIWAN SCHOLARSHIP

INSTRUCTIONS:

This application form should be typed and completed by the applicant. Each question must be answered clearly and completely. Detailed answers are required in order to make the most appropriate arrangements. If necessary, additional pages of the same size may be attached.  本表請申請人詳實工整填寫,慎勿遺漏,以利配合作業,如有需要,申請人可自行以同款紙張加頁說明。

Please check. 請選以下選項

Which type of scholarship are you applying for? □   Undergraduate Scholarship大學獎學金□   Master Scholarship碩士獎學金

□   Doctoral Scholarship 博士獎學金

Do you need to attend a Chinese Language Enrichment Program (The LEP program must be undertaken during the first year)? Yes No (If “yes”, please fill in the name of the language center for item 7 on page 4 and apply for admissions to a degree program for the 2018 academic year.)

  1. PERSONAL DATA 個人基本資料
a.NAME姓名 Title 稱謂: Mr./Mrs./Ms.SurnameLast name)姓:Given Name(s) 名:

Chinese Name 中文姓名:

Please attach a recent photograph taken within the last 3 months.最近三個月相片
b. CITY and COUNTRY OF BIRTH 出生.城市及國別  
c. NATIONALITY國籍 *Note: If one or both of your parents was an ROC national at the time of your birth, you are an ROC national as well and therefore not eligible to apply.
d. PARENTS’ INFORMATION
家長資料

FATHER 父

MOTHER
Name姓名:Nationality國籍:Place of Birth出生地:

 

Name姓名:Nationality國籍:Place of Birth出生地:

 

e. CONTACT INFORMATION聯絡地址、電話、電子郵件 Permanent Address永久地址:Mailing Address (If different from above)郵寄地址:Telephone電話:               E-mail電子郵件:

Cell  phone 手機:

 

 

f. SEX性別            Male        Female
g. MARITAL STATUS
婚姻狀況
Single單身       Married 已婚
h. DATE of BIRTH
生日
  (Day日/Month 月/Year ):                    
i. PAST RESIDENCE in TAIWAN居住臺灣 Never Yes, from           (dd/mm/yr) to           (dd/mm/yr).是,起迄日期reason for residence居住事由:
j. Taiwan Scholarship/ Huayu Enrichment Scholarship Award History臺灣獎學金/華語文獎學金受獎紀錄 None Yes, from           (dd/mm/yr) to           (dd/mm/yr);是,起迄日期Type(s) of Scholarship Awarded:
k. HEALTH CONDITION
健康狀況
Excellent      Good    □ Fair
l CHRONIC DISEASES 慢性病  None     Yes有─Please specify請指明:
m. CONTACT PERSON, IN CASE OF AN EMERGENCY   緊急事件聯絡人 Name姓名:                             Relationship 關係:Address地址:Telephone 電話:                          E-mail 電子郵件:

Cell phone 手機:

  1. LANGUAGE PROFICIENCY語言能力

LANGUAGE

PROFICIENCY   語言能力

COMPREHENSION READING WRITING SPEAKING
Excellent
Good Fair
Excellent Good Fair Excellent Good Fair Excellent Good Fair
CHINESE                        
ENGLISH                        
(Other, please state)                        
  1. EDUCATIONAL BACKGROUND 教育背景
Level 程度 Name of Institution
校名
Country & Place地點 Period of Enrollment
修業年限
Secondary Education 中學      
Undergraduate Level Education      
Graduate Level Education 研究所      
  1. REFERENCES 推薦單位 () 資料
Name 姓名 Position職務 Telephone , E-Mail or Mailing Address電話及郵電地址
     
     
  1. PREVIOUS EMPLOYMENT (Use one line for each position) 工作經歷
Position 職務 Company/Organization機構名稱 Period of Employment
服務期間
 Responsibilities 工作說明
       
       
       
  1. PRESENT EMPLOYMENT 現職狀況
a. COMPANY/ ORGANIZATION  機構名稱                   
b. POSITION
職稱
  c. From起始日期
d. CONTACT   INFORMATION
聯絡資訊
Address 地址:Telephone 電話:                     Cell phone 手機:Fax 電傳:                           E-mail 電子郵件:
e. TYPE OF ORGANIZATION   機構種類 Govt. Ministry/                      University/                           Govt./State-owned
Agency
政府部門                Institution大學校院                  Enterprise 公營企業Locally-owned                      Joint Venture  International         NGO
Enterprise
私人企業           合資企業        Enterprise 國際公司  非政府國際組織
f. PRESENT DUTIES & YEARS OF EMPLOYMENT現任職務及資歷年限  
  1. LANGUAGE CENTER OR/AND UNIVERSITY/DEPARTMENT WHICH YOU PLAN TO ATTEND IN TAIWAN擬就讀之語文中心或及大學校院系所
University affiliated language center:
University/college and department:
  1. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN請簡述在臺讀書計畫
   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. DECLARATION: I declare that:
  • I am neither concurrently an ROC national, nor an overseas compatriot of the ROC;
  • I am not currently undertaking studies in Taiwan for the same educational level as the scholarship type for which I am applying;
  • I am not applying for this scholarship as an exchange student resulting from an agreement signed between my home institution and any Taiwan university/college;
  • The information I have given on this application is complete and accurate to the best of my knowledge.
 Applicant’s Signature                                   Date                                   

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