国立中央大学外国交换学生申请表.docVIP

中央大學交換學生申請表 National Central University Exchange Student Application Form Notice: Please type or print clearly. This application form should be submitted together with the dormitory application. Please send the application before the stated deadline. 兩吋照片1張 Paste photo here (size:2”x2”) 學號Student Number (由中央大學教務處填寫To be completed by Academic Office) 姓名 Name 中文Chinese 英文English 國籍 Nationality 中 國 性別 Gender ( 男Male ( 女Female 生日 Date of Birth ______/______/________ Day Month Year 最高學歷 Highest Academic Degree ( 博士Doctor ( 碩士Master ( 學士Bachelor 原就讀校名 Home University 原系所別 Department/Institute (Home University) 申請中大 系（所）別 Department in NCU 第一志願 緊急連絡 Emergency Contact 聯絡人姓名Contact Person ___________________________________________ ________________________________________________ 聯絡電話Phone No. ________________________________________________ 通訊處 Address 永久地址Permanent Address______________________________________________________________ 通訊地址Mailing Address_______________________________________________________________ Email____________________________ Phone No._______________________ 修讀期間 Study Period 請勾選中央大學之修讀期間Please specify the semester in which you would like to study at NCU. One year will be acceptable. (上學期(九至二月) Fall Semester (September to January) Year __________ (下學期(二至六月) Spring Semester (February to June) Year __________ (一學年(九至六月) Both Semesters (September to June) (一學年(二月至一月) Both Semesters (February to January) 證明文件 Identification Document (ID (No. ) (護照Passport (No. ) (居留證Alien Residence Certificate (No. ) (保險Health/Medical Insurance (No. ) 浮貼身分證/護照正面影本(Paste front page of ID or passport) 浮貼身分證/護照反面影本(Paste reverse page of ID or passport) 浮貼學生證/正面影本(Paste front page of ID or passport) 浮貼學生證/反面影本(Paste reverse page of ID or passport) 姐妹校認證