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Formulaire de candidature BU/TSP

臺灣獎學金申請表(2017-2018)

APPLICATION FORM FOR A TAIWAN SCHOLARSHIP (2017-2018)

INSTRUCTIONS:

This application form should be typed in English or Chinese 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. 本表請申請人以英文或中文詳實打字工整填寫,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 type of scholarship are you applying for?

Undergraduate Scholarship大學獎學金

Master Scholarship碩士獎學金

Doctoral Scholarship 博士獎學金

1. PERSONAL DATA 個人基本資料

a.NAME姓名 (Please make sure same as in Passport )

Title 稱謂: Mr./Mrs./Ms.

SurnameLast 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.城市及國別


c. NATIONALITY國籍

Passport Number :____________________ (Expiry Date : ______________ )

*Note: If one or both of your parents was a ROC national at the time of your birth, you are a ROC national as well and therefore not eligible to apply.

d. PARENTS’ INFORMATION
家長資料

FATHER

MOTHER

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、電子郵件

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 手機:

f. SEX性別

Male Female

g. MARITAL STATUS
    
婚姻狀況

Single單身 Married 已婚

h. DATE of BIRTH
生日

(Day日/Month 月/Year ):

i. PAST RESIDENCE in

TAIWAN居住臺灣

Never ; 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 ; 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

None

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 電子郵件:

Cell phone 手機:





2. LANGUAGE PROFICIENCY語言能力

LANGUAGE

PROFICIENCY 語言能力

COMPREHENSION

READING

WRITING

SPEAKING

Excellent

Good

Fair

Excellent

Good

Fair

Excellent

Good

Fair

Excellent

Good

Fair

CHINESE













ENGLISH













(Other, please state)













3. EDUCATIONAL BACKGROUND 教育背景

Level 程度

Name of Institution
校名

Country &City

地點

Period of Enrollment
修業年限

Secondary

Education 中學




Undergraduate Level Education




Graduate Level Education 研究所




4. REFERENCES 推薦單位 () 資料

Name 姓名

Position職務

Telephone , E-Mail or Mailing Address電話及郵電地址







5. PREVIOUS EMPLOYMENT (Use one line for each position) 工作經歷

Position 職務

Company/Organization

機構名稱

Period of Employment
服務期間

Responsibilities

工作說明













6. PRESENT EMPLOYMENT 現職狀況

a. COMPANY/ ORGANIZATION

機構名稱


b. POSITION
職稱


c. From起始日期

d. CONTACT INFORMATION
聯絡資訊

Address 地址:

Telephone 電話: Cell phone 手機:

Fax 電傳: E-mail 電子郵件:

e. TYPE OF ORGANIZATION 機構種類

Govt. Ministry/ University/ Govt./State-owned
Agency
政府部門 Institution大學校院 Enterprise 公營企業

Locally-owned Joint Venture International NGO
Enterprise
私人企業 合資企業 Enterprise 國際公司 非政府國際組織

f. PRESENT DUTIES & YEARS OF EMPLOYMENT

現任職務及資歷年限


7. UNIVERSITY/DEPARTMENT, WHICH YOU PLAN TO ATTEND IN TAIWAN擬就讀之大學校院系所

University/college and department:

Teaching language used in the program you applied for (please check this point directly with the University) :

all English all Chinese or Chinese & English

8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN請簡述在臺讀書計畫


9. DECLARATION: I declare that:

I am neither concurrently an ROC national, nor an overseas compatriot of the ROC;

I am not currently undertaking studies in Taiwan for the same educational level as the scholarship type for which I am applying;

I am not applying for this scholarship as an exchange student resulting from an agreement signed between my home institution and any Taiwan university/college;

The information I have given on this application is complete and accurate to the best of my knowledge.

10. CHECK LIST

Application Form.

A copy of the applicant’s passport or other nationality certificates.

A copy of the highest degree and academic transcripts.

A copy of admission application materials to universities/colleges in Taiwan

A copy of a language proficiency certificate:

1. A copy of results or certificate for the “Test of Chinese as a Foreign Language” (TOCFL) Level3 or above.

2. For applications to all-English programs, a copy of TOEFL test scores or other recognized English language proficiency exams or degrees awarded in English must be submitted. English-speaking nationals are exempt from this rule.

Two letters of reference signed and sealed in envelopes (i.e. from the principals, professors, or supervisors). Photo copies and email submissions of letters of recommendation will not be considered.

Additional documents as specified by the individual representative offices.

Applicant’s Signature

Date

_____ /_____/_____



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