Name in Cinese中文姓名.docVIP

Name in Chinese中文姓名 Name in English / in own language 照 片 Photo Last name 姓 First Middle 名 Nationality 國籍 Birth Place 出生地 DOB(Y/M/D)生日 Gender 性別 Present Occupation 現任職務 Education Background教育程度 Native Language 母語 Term Applying For 欲申請就讀期別 □ Spring Term春季班 □ Summer Term夏季班 □ Autumn Term 秋季班 □ Winter Term 冬季班 Taiwan Address台灣居住地址 Phone Number 電話號碼 (H)家 （M）手機 (O)公司 Email電子信箱 Passport No.護照號碼 ______________________ Date of expiration有效期限 Year __________ Month ________ Date ________ Contact Person in Taiwan在台聯絡人 Name Phone Number Permanent Address永久居住地址 Contact Person’s Name (in own country) Phone Number Have you ever studied Chinese before? □ No否 □ Yes是 If yes, When _____________ How long _____________ Where ____________________ Please use approximately 50 Chinese words or Hanyu pinyin to introduce yourself and your study objectives. The purpose of this is for us to understand your Chinese level. Please don’t use translator. You can write in English if you do not have any Chinese training. 請用中國字或拼音簡述自傳及學習目標。讓我們了解您的中文程度。請自行填寫，勿使用翻譯軟體。若未學過中文，亦請註明。 個人資料保護法聲明 Statement of Personal Information Protection Act 本人同意及授權文藻外語學院華語中心所蒐集之個人資訊僅作為文藻華語中心之課務、活動及相關行政業務之使用，亦了解該中心將依個人資料保護法之相關規定妥善管理，未經本人同意，絕不任意對其他第三者揭露。I hereby consent and authorize Center of Chinese Language (CCL) of Wenzao Ursuline University of Languages to collect the personal information that I provide for the purpose of affairs of courses, activities and administrative work in CCL. I also understand that CCL will protect the information well in accordance with Personal Information Protection Act. The information will not be disclosed to third parties without my agreement. Applicant’s Signature / Date _____________________________ For office use only □護照或居留證 □照片 □保險證明 □財力證明 □最高學歷證明 □健康檢查表 □註冊費及學費 □寄發入學許可書,日期: 請翻至背面並回答問卷之問題，謝謝！Please turn to the reverse page and answer questions. Thank you ! 請回答以下問題，謝謝！Please answer