大仁科技大学外国籍学生奖助学金申请表模板.doc

大仁科技大學外國籍學生獎助學金申請表
Tajen University Foreign Student Scholarship Application Form

Please complete in English except where asked to use Chinese.

1. Name姓名 : (in English):

Name姓名:: (in Chinese):

Title抬頭:

2. Sex姓別:

3. Marital Status婚姻狀況:

4. Nationality國籍:

5. Date of Birth生日:

6. Contact address聯絡住址: (in Chinese)

………………………………………………………………………………………………………………
7. Contact address聯絡住址: (in English)

………………………………………………………………………………………………………………

Tel (H): ………………………….. (O): …………………………
Fax / Email: …………………….………………………………….

8. Education Background (Please enclose certified Chinese or English translations of your transcripts.) 　教育背景(請附上汉字或英文之在學成績單)
Institution 學校

From (d/m/y)
To (d/m/y)
Major　主修
Qualification Obtained　學歷

9. Employment Background 就業背景
Please provide details of past and current work experience
Employer 　

From (d/m/y)
To (d/m/y)
Position & Nature of Duties

10. Additional Information 其她個人資訊
(Please provide information about the reasons for choosing your area of study or research, any relevant work experience; and your intended future career.)

11. Chinese Language Proficiency　汉字程度
Please provide evidence of your Chinese Language ability.
To what extent do you use Chinese in your work or in your studies?

12. Universities Applied　其她已申請之學校（請列出您已申請之學校及系所）
(Please give details, in order of preference, of the universities and courses for which you have applied)

Institution Name
學校名稱
Course Name
系所名稱
Type of Qualification
(e.g. BS,MA, MSc,) 學位
Current status of application *申請狀況

1.

2.

3.

4.

5.

* If you have not received an offer yet, please write NO
* If you have been awarded an unconditional offer, please write UCO
* If you have been awarded a conditional offer, please write CO
(Please enclose a copy of your letter of offer)

13. Date Available for Study in Taiwan, ROC? ….….day…….month…….year

何時可在臺灣就讀?
14. Referees　推薦人
(Please ask two people to provide written references on your behalf, using the standard form. Please copy the standard form if you need more copies.)

Referee 1 Referee 2

Name

Name

Occupation

Occupation

Address

Address

Telephone

Telephone

15. Declaration 聲明
I certify that I am normally resident in and that, to the best of my belief, the statements made in this application are true. I have read and understood the Scholarship Regulations.

Signature:

Date:

請填妥申請書連同其她文件, 於6月30日前郵寄至以下地址:
Please send your completed application form, together with all dossiers, to the Office of Academic Affairs at the address below to arrive no later than June 30, :

Center of International Cooperation
Tajen University
No. 20, Wei-Shin Rd.,
Shin-Er Tsun, Yan-Pu Hsiang,
Pingtung 907, Taiwan