台灣獎學金申請表
APPLICATION FORM FOR TAIWAN SCHOLARSHIPS
2008-2009
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.  本表請申請人詳實工整填寫，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 would you like to apply for?
□ Undergraduate Scholarship大學獎學金
□ Master Scholarship碩士獎學金
□ Doctoral Scholarship 博士獎學金
Do you need to attend a Chinese Language Enrichment Program? □ Yes □ No (If “yes”, please fill in the name of the university-affiliated language center on page 4, item 7.)
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：b.PLACE OF BIRTH
出生地Please attach a photograph that has been taken within the last 3 months.
最近三個月相片
c. NATIONALITY國籍
Note: Foreign students who are concurrently holding a T aiwan nationality are not eligible to apply.
FATHER 父 MOTHER
母
d. PARENTS’ INFO. 家長資料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：
f.SEX性別□Male 男
□Female女g.MARITAL STATUS
婚姻狀況
□Single單身
□Married 已婚
h.DATE OF BIRTH
生日
(Day日／Month 月／Year 年):
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. 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
Degree received/ Year
文憑/獲文憑年度
Secondary
Education 中學
Undergraduate
Level Education 大學
Graduate Level
Education 研究所
3. REFERENCES 推薦單位(人) 資料
Name 姓名Position職務Phone Number , E-Mail or Mailing Address電話及郵電地址4. LANGUAGE PROFICIENCY語言能力
COMPREHENSION
聽
READING 讀 WRITING 寫 SPEAKING 說
LANGUAGE PROFICIENCY  語言能力
Excellent
優 Good 良
Fair 可
Excellent
優 Good 良
Fair 可
Excellent
優 Good 良
Fair 可
奖学金申请表
Excellent
優
Good 良
Fair 可
CHINESE
ENGLISH
Other, please
state
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  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 OR/AND UNIVERSITY/DEPARTMENT, WHICH YOU PLAN TO ATTEND IN TAIWAN擬就讀之語文中心或⁄及大學校院系所
(For information about university-affiliated language centers in T aiwan, please visit the official govern
ment website for advice on study in T aiwan at v.tw/fp.asp?xItem=677&ctNode=417&mp=1)
University affiliated language center:
University/college and department:
8. PLEASE BRIEFLY STATE YOUR STUDY PLAN WHILE IN TAIWAN請簡述在台讀書計畫
9. DECLARATION:I declare that:
□ I am not concurrently holding a Taiwan’s nationality;
□ I am not currently studying in a program at the same educational level as the scholarship for which I am applying;
□ I am not an exchange student resulting from an agreement signed between my home institution and with any Taiwan university/college;
□ The information I have given on this application is complete and accurate to the best of my knowledge.
Applicant’s Signature
Date                                                        _____ /_____/_____