南亚技术学院国际语文教学中心.docVIP

南亞技術學院國際語文教學中心 華語入學申請表 APPLICATION FOR ADMISSION Nanya Institute of Technology 請以正楷填寫正反兩面。 Please type or print clearly. Complete both sides of the application form. 中文姓名/Chinese Name 2. 英文姓名(與護照相同)/English Name (as shown on passport) (名/Given Name) (姓/Surname) 3. 出生日期/Date of Birth (Month)(Day)(Year) 4. 性別/Gender □ 男/Male □女/Female 5. 國籍/Nationality 6. 護照號碼/Passport No. 7. 通訊地址/Mailing Address 電話/Tel: 電子郵件(必填)/E-mail(Required): 8. 緊急聯絡人(父母或親友)/Emergency Contact Person (Parents, relatives or close friends) 姓名/Name: 關係/Relationship： 電話/Tel: 電郵/E-mail Address: 9. 在台聯絡人(若無則可不填)/Contact Person in Taiwan (leave this column blank if none) 姓名/Name: 關係/Relationship： 電話/Tel: 電郵/E-mail Address: 10. 最高學歷/ Highest Education Qualification 學 (1)校名稱及所在地/School, City and Country: (2)主修/Major: (3) □在學/Still at school□已畢業/Graduated 11. 請勾選你要上課的期別/Please tick the term(s) you wish to study □團體班 Group classes □個人班 Individual classes □入門級 Beginner □基礎級 Basic □進階級 Intermediate □高階級 Advanced □流利精通級 Fluent level (1) □一對一課程one-on-oneclass (2) □學季制課程Quarter Session (3□華語文短期課程Short-term Course (4) □學年制華語文課程 Regular Group Class (4 quarters each year) □上學期/1stsemestery月month □下學期/2nd semester y 月month □201年春季期/Spring 201 □2015年夏季期/Summer 201 □2015年秋季期/autumn 201 2015年冬季期/Winter 201 12. 住宿申請(請選擇想申請的房型)/Housing Application(tick two both items if necessary) 學生五人房宿舍(費用：每學期11,000元)/ dormitory (five beds/room): NT$ 11,000/semester 學生三人房宿舍(費用：每學期11,000元)/ dormitory (three beds/room): NT$ 11,000/semester 學生五人房宿舍(費用：每三月6,000元)/ dormitory (five beds/room): NT$ 6,000/3 months 各式房間數量有限，住宿申請結果及繳費方式於各期報名截止日後十五日在本中心網站公告。Limited housing availability. The result of housing application and payment instruction will be posted online within 15 days after the application deadline. 13. English proficiency 英文能力 Reading/讀□Excellent 優□Good良□Fair可□Poor差 Writing/寫□Excellent 優□Good良□Fair可□Poor差 Listening/聽□Excellent 優□Good良□ Fair可□Poor差 Speaking