国立政治大学社会科学学院.docVIP

國立政治大學社會科學學院 7-2018 College of Social Sciences National Chengchi University Application Form for Academic Exchange 2017-2018 欲申請之系所 Department to apply: Period of Exchange: ?? 2017 Fall / ?? 2018 Spring / ?? 2017 Fall 2018 Spring 請用中文或英文書寫 Please fill in the following form in Chinese or English 個人資料Personal Information 姓 Last Name 請黏貼個人照片 Please a passport-sized photo here 名 First Name Middle Name 中文姓名 Chinese Name if any (please write down in Chinese characters) 性別 Gender (男性Male ( 女性Female 出生年月日 Date of Birth (yyyy/mm/dd) 國籍 Nationality 護照號碼 Passport No. 聯絡電話 Telephone no. (country code) - (area code) 通訊處 Mailing Address 電子郵件信箱 E-mail address 學歷 Education (Please List Bachelor nd Above Degree Only) 學位 Degree 學校名稱/國家 Name of School/ Country 主修科目 Major 修業期間 ( From / To ) 畢業與否 Graduate (Y / N) 社團/活動經歷 Extracurricular Experience at Schools 社團/活動名稱 Name of Club/ Activity 幹部名稱 Title / Position 工作內容 Major Responsibilities 參加期間 From / To 語言能力 Language ( Fluent / Good / Intermediate/ Limited ) 語言 Language 聽 Listening 說 Speaking 讀 Reading 寫 Writing 中文 Chinese 研究計畫 Study Plan/ Research Proposal (in Chinese or English ) 6. 其他事項 Others 1.請敘明在華研習期間各項費用來源 What are your major financial resources during your stay NCCU? (個人儲蓄 Personal Savings (獎(助)學金 Scholarship (父母供給 Parental Support (其他 Other (Specify) 2.請問是否申請學校宿舍? Dorm Reservation? (是Yes (否No 3.在台灣的聯絡人Contact person in Taiwan ( If any) 姓名Name: 聯絡電話Tel: I declare that the information provided in this application is accurate and complete. I understand that any false or misleading informatio