Taiwan Language Scholarship Application Form

教育部華語文獎學金申請表
Application Form for
ROC (Taiwan) Ministry of Education Mandarin Enrichment Scholarships


INSTRUCTIONS:
This application form should be typed 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. 申請人請詳實工整填寫，慎勿遺漏，以利配合作業，如有需要，可自行以同款紙張加頁說明。
1. PERSONAL DATA 個人基本資料
a.NAME姓名 Title 稱謂： Mr./Mrs./Ms.
Surname（Last name）姓：
Given Name(s) 名：
Chinese Name 中文姓名： Please attach a photograph that has been taken within the last 3 months.
最近三個月相片
b. PLACE OF BIRTH
出生地
c. NATIONALITY國籍 Note: Foreigners who are concurrently holding a Taiwan nationality are not eligible to apply.
d. 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：

e. SEX性別 □ Male 男　 □ Female女
f. MARITAL STATUS
婚姻狀況 □ Single單身 □ Married 已婚
g. DATE OF BIRTH
生日 (Day日／Month 月／Year 年):

h. HEALTH CONDITION
健康狀況 □ Excellent □ Good □ Fair
i. ANY CHRONIC DISEASES 慢性病 □ None無
□ Yes有 If yes, Please specify. 如有請指明

j. CONTACT PERSON, IN CASE OF EMERGENCY
緊急事件聯絡人 Name姓名: Relationship 關係:
Address地址:
Tel電話: E-mail 電子郵件:
2. LANGUAGE PROFICIENCY語言能力
LANGUAGE
PROFICIENCY 語言能力 COMPREHENSION聽 READING 讀 WRITING 寫 SPEAKING 說
Excellent
優 Good良 Fair
可 Excellent優 Good良 Fair可 Excellent優 Good良 Fair可 Excellent優 Good良 Fair
可
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 大學
Graduate Level Education 研究所


4. REFERENCES 推薦單位 (人) 資料
Name 姓名 Position職務 Phone , E-Mail or Mailing Address電話及郵電地址


5. PREVIOUS EMPLOYMENT 工作經歷 (Use one line for each position)
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 INFO. 聯絡資訊 Address 地址：
Tel 電話：
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 □ Foreign-owned □ NGO
Enterprise私人企業 合資企業 Enterprise 國際公司 非政府機構
7. LANGUAGE CENTER WHICH YOU PLAN TO ATTEND IN TAIWAN擬就讀之語文中心 (For information about university-affiliated language centers in Taiwan, pleaser visit the official government website for advice on study in Taiwan at http://www.studyintaiwan.org)
University affiliated language center:
8. Duration 擬申請之受獎期限
The following are four options for a recipient to choose from, regarding the award periods:
□ One year (1年)
□ Nine months ( 9個月)
□ Six months (6個月)
□ Three months (3個月)
□ Two months (3個月)
9.PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN請簡述在台讀書計畫

10. DECLARATION:
I declare that:
 The information I have given on this application is complete and accurate to the best of my knowledge.
Applicant’s Signature Date
_____ /_____/_____