台湾奖学金申请表.doc

臺灣獎學金申請表 APPLICATION FORM FOR TAIWAN SCHOLARSHIPINSTRUCTIONS: 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 of scholarship are you applying for? Undergraduate Scholarship大學獎學金 Master Scholarship碩士獎學金 1. PERSONAL DATA 個人基本資料 a.NAME姓名 Title 稱謂： Mr./Mrs./Ms. Surname（Last 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. 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. ’ INFORMATION家長資料 FATHER 父 MOTHER 母 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、電郵 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 : f. SEX性別 □ Male 男 □ Female女 . MARITAL STATUS 婚姻 □ Single單身 □ Married 已婚 h. DATE of BIRTH 生日 (Day日／Month 月／Year 年): i. PAST RESIDENCE in TAIWAN□Never 否; □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 無; □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 □ No無 □ 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 郵: Cell phone 手機: 2. LANGUAGE PROFICIENCY語言能力